Department of Oncology, University General Hospital of Guadalajara, Calle Donante de Sangre, S/N, 19002, Guadalajara, Spain.
Department of health economics and market access, Janssen-Cilag, Paseo Doce Estrellas 5-7, 28042 Madrid, Spain.
Cancer Treat Rev. 2021 Feb;93:102152. doi: 10.1016/j.ctrv.2020.102152. Epub 2021 Jan 11.
To evaluate the impact of the hormonal treatment sequencing including abiraterone acetate plus prednisone (AAP) and enzalutamide (ENZ) in mCRPC, and determine which sequence provides more benefits for patients.
Studies published in English between 1 January 2013 and 30 September 2017 were identified in PubMed and EMBASE electronic databases. Studies assessing the efficacy of treatment sequences, based on AAP and ENZ, in mCRPC patients, were eligible for analysis.
Seventeen studies met the inclusion criteria. Two assessed both treatment sequences AAP → ENZ and ENZ → AAP; it was found that sequence of AAP → ENZ showed a statistically significantly longer PSA-PFS than the observed in ENZ → AAP (pooled HR: 0,54; 95% CI; 0,36-0,82; p < 0,05). The nine studies analysing Doc → AAP → ENZ sequence, revealed favourable results in terms of PFS. The 5 studies which analysed AAP → ENZ sequence, show a decrease in PSA levels ≥ 50% in 11-41% of patients treated with enzalutamide after previous treatment with AAP. In the two studies that analysed the Doc → ENZ → AAP sequence, PSA response rates were much lower than those reported with Doc → AAP → ENZ, with decreases in PSA ≥ 30 of 3-18% and PSA ≥ 50 of 8-11%.
Significant clinical efficacy of AAP administered as the first-line treatment in mCRPC patients followed by enzalutamide, delaying disease progression, compared with the ENZ → AAP sequence. However, more studies and randomized trials are needed, to validate the best treatment sequencing.
评估包括醋酸阿比特龙加泼尼松（AAP）和恩扎鲁胺（ENZ）在内的激素治疗序贯治疗在 mCRPC 中的影响，并确定哪种治疗顺序为患者带来更多获益。
检索 2013 年 1 月 1 日至 2017 年 9 月 30 日期间发表在 PubMed 和 EMBASE 电子数据库中的英文文献。纳入评估基于 AAP 和 ENZ 的治疗顺序在 mCRPC 患者中的疗效的研究。
共纳入 17 项研究。其中两项研究评估了 AAP→ENZ 和 ENZ→AAP 两种治疗顺序，结果发现 AAP→ENZ 序贯治疗的 PSA-PFS 明显长于 ENZ→AAP 序贯治疗（合并 HR：0.54；95%CI：0.36-0.82；p<0.05）。9 项分析 Doc→AAP→ENZ 序贯治疗的研究结果显示该序贯治疗在 PFS 方面有获益。5 项分析 AAP→ENZ 序贯治疗的研究显示，11%-41%接受恩扎鲁胺治疗的患者 PSA 水平下降≥50%，这些患者之前接受过阿比特龙治疗。两项分析 Doc→ENZ→AAP 序贯治疗的研究显示，PSA 缓解率远低于 Doc→AAP→ENZ 序贯治疗，PSA 下降≥30%的比例为 3%-18%，PSA 下降≥50%的比例为 8%-11%。
与 ENZ→AAP 序贯治疗相比，醋酸阿比特龙作为一线治疗用于 mCRPC 患者，随后序贯使用恩扎鲁胺能显著提高患者的临床疗效，延缓疾病进展。然而，还需要更多的研究和随机试验来验证最佳的治疗顺序。
