Liman Andrew, Shah Rashmikant, Passero Vida, Tan Jocelyn, Rai Hema, Harrold Laurie, Tokarsky Joyce, Liman Agnes, Gupta Vidhi, Gerszten Kristina
is Section Chief, Hematology/Oncology and is a Physician, Pathology and Laboratory Medicine, both at VA Central California Health Care System in Fresno. is Section Chief; , , and are Physicians; is a Nurse Practitioner, all in the Hematology/Oncology section at VA Pittsburgh Health Care System (VAPHCS) in Pennsylvania. , , and are Physicians in the Radiology and Radiation Oncology section at VAPHCS. Andrew Liman is an Assistant Clinical Professor of Medicine at the University of California San Francisco at Fresno. Vida Passero, Laurie Harrold, Jocelyn Tan, and Hema Rai are Assistant Clinical Professors of Medicine at University of Pittsburgh Cancer Institute in Pennsylvania.
Fed Pract. 2020 Dec;37(12):570-574. doi: 10.12788/fp.0062.
Radium-223 (Ra-223) radioisotope has been reported to increase median survival in bone metastatic prostate carcinoma. The addition of Ra-223 to abiraterone was associated with an increased risk of bone fractures. There has been no comprehensive data for using Ra-223 in veterans who were exposed to Agent Orange (AO+).
We present a retrospective study of veterans with bone metastatic castration-resistant prostate cancer (CRPC) who received standard doses of Ra-223 and other sequential therapies at US Department of Veterans Affairs Pittsburgh Healthcare System in Pennsylvania from January 2014 to January 2019. Veterans were divided into 2 groups: those who were exposed to Agent Orange (AO+) and those who had no exposure (AO-). Time to study was calculated from the initiation of Ra-223. Time to skeletal-related events (SRE), progression of prostate specific antigen (PSA), bone metastasis, and alkaline phosphatase (ALP) were calculated in months using unpaired t test with 2-tailed values. Median survival was calculated by Kaplan Meier R log-rank test.
There were 34 veterans with bone metastatic CRPC: 17 veterans (50%) were AO+ and 17 veterans (50%) were AO-. The mean age of diagnosis of AO+ veterans was 62 years and 69 years ( = .005) for AO- veterans (the mean Gleason score 8.2 and 8.0, respectively [ = .71]). The median number of Ra-223 cycles was 6 (60%). Ten veterans received Ra-223 as first line (29%) and 24 veterans received Ra-223 later (71%). There were 12 SREs with median survival of 15 months. There was no difference in mean time to SRE between AO+ (8 veterans, 10.6 months) and AO- (4 veterans, 10.3 months) ( = .93). The mean time to PSA progression for AO+ was 5.4 months and AO- was 6.8 months ( = .28). Mean time to bone progression for AO+ was 7.6 months and AO- was 10.1 months ( = .16). Mean time to ALP progression for AO+ and AO- was 6.3 months and 8.7 months, respectively ( = .05). Twenty veterans (58%) had died. Median survival for Ra-223 first was 32 months and for Ra-223 later was 15 months ( = .14; hazard ratio [HR] 0.48; 95% CI, 0.17-1.3). Median survival for AO+ and AO- veterans was 12 months and 18 months, respectively ( = .15; HR, 2.0; 95% CI, 0.77-5.0).
There was no statistical difference between AO+ and AO- veterans in terms of time to SRE, PSA, bone and ALP progression, even though there was a trend of shorter duration in AO+ veterans. There was no median survival difference between Ra-223 first vs Ra-223 later as well as between AO+ and AO- but there is a trend of worse survival in AO+ veterans.
据报道，镭 - 223（Ra - 223）放射性同位素可延长骨转移性前列腺癌的中位生存期。在阿比特龙基础上加用Ra - 223会增加骨折风险。目前尚无关于在接触过橙剂的退伍军人（AO +）中使用Ra - 223的全面数据。
我们对2014年1月至2019年1月期间在宾夕法尼亚州匹兹堡退伍军人事务部医疗系统接受标准剂量Ra - 223及其他序贯治疗的骨转移性去势抵抗性前列腺癌（CRPC）退伍军人进行了一项回顾性研究。退伍军人分为两组：接触过橙剂的（AO +）和未接触过的（AO -）。研究时间从开始使用Ra - 223计算。使用双侧P值的非配对t检验以月为单位计算至骨骼相关事件（SRE）、前列腺特异性抗原（PSA）进展、骨转移和碱性磷酸酶（ALP）进展的时间。通过Kaplan - Meier R对数秩检验计算中位生存期。
共有34例骨转移性CRPC退伍军人：17例退伍军人（50%）为AO +，17例退伍军人（50%）为AO -。AO +退伍军人的平均诊断年龄为62岁，AO -退伍军人为69岁（P = 0.005）（平均Gleason评分分别为8.2和8.0 [P = 0.71]）。Ra - 223的中位疗程数为6个（60%）。10例退伍军人将Ra - 223作为一线治疗（29%），24例退伍军人后来接受Ra - 223治疗（71%）。发生12次SRE，中位生存期为15个月。AO +组（8例退伍军人，10.6个月）和AO -组（4例退伍军人，10.3个月）至SRE的平均时间无差异（P = 0.93）。AO +组至PSA进展的平均时间为5.4个月，AO -组为6.8个月（P = 0.28）。AO +组至骨转移进展的平均时间为7.6个月，AO -组为10.1个月（P = 0.16）。AO +组和AO -组至ALP进展的平均时间分别为6.3个月和8.7个月（P = 0.
