Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Jhong Siao Urological Hospital, Kaohsiung, Taiwan.
Medicine (Baltimore). 2023 Feb 3;102(5):e32671. doi: 10.1097/MD.0000000000032671.
While radium (Ra)-223 is among the multiple, known life-prolonging treatments in bone-predominant metastatic castration-resistant prostate cancer (mCRPC), optimal treatment sequencing has not been determined, particularly in the Asia-Pacific context. Hence, we aimed to compare treatment outcomes of docetaxel-naïve and post-docetaxel mCRPC patients undergoing Ra-223 therapy in Taiwan. Using a single-center retrospective cohort design, we reviewed records of adult patients receiving Ra-223 for bone-metastatic mCRPC from 2018 to 2021. Patients were categorized into docetaxel-naïve or post-docetaxel groups based on history of docetaxel use preceding Ra-223. We compared the 2 groups in terms of all-cause death, 6-cycle treatment completion, and the following secondary outcomes: pain control, change in biochemical parameters (prostate-specific antigen, lactate dehydrogenase, alkaline phosphatase), biochemical response, and treatment-emergent adverse events. We performed total population sampling and a complete case analysis. We included 48 patients (25 docetaxel-naïve, 23 post-docetaxel) in the study. The mean follow-up duration was 12.4 months for the entire cohort. The docetaxel-naïve group exhibited a significantly lower all-cause mortality rate versus the post-docetaxel group (40.0% vs 78.3%, P = .02), as well as a significantly higher treatment completion rate (72.0% vs 26.1%, P < .01). We did not find significant differences in pain control, change in biochemical parameters, biochemical response, or hematologic treatment-emergent adverse events between the 2 groups. However, the docetaxel-naïve group had a numerically higher pain control rate, numerically greater improvements in alkaline phosphatase and prostate-specific antigen, and numerically lower rates of grade ≥ 3 neutropenia and grade ≥ 3 thrombocytopenia than the post-docetaxel group. Use of Ra-223 in docetaxel-naïve patients with mCRPC led to lower mortality and higher treatment completion than post-docetaxel use. Our study adds preliminary real-world evidence that Ra-223 may be used safely and effectively in earlier lines of treatment for bone-predominant mCRPC. Further large-scale, longer-term, and controlled studies are recommended.
虽然镭-223（Ra-223）是多种已知的延长生存期的治疗方法之一，用于治疗以骨骼为主的转移性去势抵抗性前列腺癌（mCRPC），但尚未确定最佳的治疗顺序，特别是在亚太地区。因此，我们旨在比较镭-223 治疗在台湾的未经多西紫杉醇治疗和多西紫杉醇治疗后的 mCRPC 患者的治疗结果。我们采用单中心回顾性队列设计，回顾了 2018 年至 2021 年间接受镭-223 治疗的患有骨骼转移的 mCRPC 的成年患者的记录。根据接受镭-223 治疗前多西紫杉醇的使用史，将患者分为未经多西紫杉醇治疗组或多西紫杉醇治疗后组。我们比较了两组的全因死亡、6 个周期治疗完成情况以及以下次要结局：疼痛控制、生化参数（前列腺特异性抗原、乳酸脱氢酶、碱性磷酸酶）变化、生化反应和治疗后不良事件。我们进行了总人群抽样和完全病例分析。我们纳入了 48 名患者（25 名未经多西紫杉醇治疗，23 名多西紫杉醇治疗后）。整个队列的平均随访时间为 12.4 个月。未经多西紫杉醇治疗组的全因死亡率明显低于多西紫杉醇治疗后组（40.0%比 78.3%，P =.02），治疗完成率明显更高（72.0%比 26.1%，P <.01）。两组之间的疼痛控制、生化参数变化、生化反应或血液学治疗后不良事件无显著差异。然而，未经多西紫杉醇治疗组的疼痛控制率较高，碱性磷酸酶和前列腺特异性抗原的改善程度较大，且≥3 级中性粒细胞减少症和≥3 级血小板减少症的发生率较低。在未经多西紫杉醇治疗的 mCRPC 患者中使用镭-223 治疗可降低死亡率并提高治疗完成率，高于多西紫杉醇治疗。我们的研究提供了初步的真实世界证据，表明镭-223 可安全有效地用于以骨骼为主的 mCRPC 的早期治疗线。建议进行进一步的大规模、长期和对照研究。
