Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Prostate. 2023 May;83(6):563-571. doi: 10.1002/pros.24488. Epub 2023 Jan 20.
We aimed to assess the oncologic efficacy of combining docetaxel (DOC) versus abiraterone (ABI) with androgen deprivation therapy (ADT) in patients with high-risk metastatic hormone-sensitive prostate cancer (mHSPC), with a focus on the efficacy of sequential therapy, in a real-world clinical practice setting.
The records of 336 patients who harbored de novo high-risk mHSPC, based on the LATITUDE criteria, and had received ADT with either DOC (n = 109) or ABI (n = 227) were retrospectively analyzed. Overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), including time to castration-resistant prostate cancer (CRPC), time to 2nd-line progression (PFS2), and 2nd- and 3rd-line PFS, were compared. We used one-to-two propensity score matching to minimize the confounders. The differential efficacy of 2nd-line therapy based on agents in each arm was evaluated using the unmatched cohort as an additional interest.
After propensity score matching, 86 patients treated with DOC + ADT and 172 with ABI + ADT were available for analyses. The 3-year OS and CSS for DOC versus ABI were 76.2% versus 75.1% (p = 0.8) and 78.2% versus 78.6% (p = 1), respectively. There was no difference in the median PFS2 (49 vs. 43 months, p = 0.39), while the median time to CRPC in patients treated with ABI was significantly longer compared to those treated with DOC (42 vs. 22 months; p = 0.006). The median 2nd-line PFS (14 vs. 4 months, p < 0.001) and 3rd-line PFS (4 vs. 2 months, p = 0.012) were significantly better in the DOC group than in the ABI group. Among the unmatched cohort, after ABI for mHSPC, the median 2nd-line PFS did not differ between the patients treated with DOC and those treated with enzalutamide as 2nd-line therapy (both 3 months, p = 0.8).
ADT with DOC or ABI has comparable oncologic outcomes in terms of OS, CSS, and PFS2 in patients with de novo high-risk mHSPC. Compared to DOC, ABI resulted in longer time to CRPC but worse 2nd and 3rd-line PFS. Further studies are needed to clarify the optimal sequence of therapy in the upfront intensive treatment era.
我们旨在评估在新诊断的高危转移性去势敏感性前列腺癌（mHSPC）患者中，与雄激素剥夺治疗（ADT）联合使用多西他赛（DOC）与阿比特龙（ABI）的抗肿瘤疗效，重点关注序贯治疗的疗效，这是在真实临床实践环境下进行的。
回顾性分析了 336 例根据 LATITUDE 标准存在新诊断高危 mHSPC 且接受 ADT 联合 DOC（n=109）或 ABI（n=227）治疗的患者记录。比较总生存期（OS）、癌症特异性生存期（CSS）、无进展生存期（PFS），包括去势抵抗性前列腺癌（CRPC）时间、二线进展时间（PFS2）、二线和三线 PFS。我们使用 1：2 倾向评分匹配以最小化混杂因素。使用未匹配队列评估每个治疗臂中二线治疗药物的差异疗效作为附加研究。
在倾向评分匹配后，86 例接受 DOC+ADT 治疗和 172 例接受 ABI+ADT 治疗的患者可进行分析。DOC 与 ABI 的 3 年 OS 和 CSS 分别为 76.2%与 75.1%（p=0.8）和 78.2%与 78.6%（p=1）。PFS2 中位数无差异（49 与 43 个月，p=0.39），但接受 ABI 治疗的患者发生 CRPC 的中位时间明显长于接受 DOC 治疗的患者（42 与 22 个月；p=0.006）。DOC 组的中位二线 PFS（14 与 4 个月，p<0.001）和三线 PFS（4 与 2 个月，p=0.012）均明显优于 ABI 组。在未匹配队列中，在接受 ABI 治疗 mHSPC 后，接受 DOC 和恩扎卢胺作为二线治疗的患者二线 PFS 中位数无差异（均为 3 个月，p=0.8）。
在新诊断的高危 mHSPC 患者中，ADT 联合 DOC 或 ABI 在 OS、CSS 和 PFS2 方面具有相似的肿瘤学结果。与 DOC 相比，ABI 导致 CRPC 发生时间延长，但二线和三线 PFS 更差。需要进一步研究阐明在强化治疗时代的最佳治疗顺序。
