接受恩杂鲁胺、醋酸阿比特龙联合泼尼松作为转移性去势抵抗性前列腺癌一线治疗的患者疾病体积的临床结局。
Clinical outcomes of volume of disease on patients receiving enzalutamide abiraterone acetate plus prednisone as first-line therapy for metastatic castration-resistant prostate cancer.
作者信息
Nuzzo Pier Vitale, Ravera Francesco, Saieva Calogero, Zanardi Elisa, Fotia Giuseppe, Malgeri Andrea, Rossetti Sabrina, Valença Loana Bueno, Oliveira Thiago Martins, Vauchier Charles, Pereira Mestre Ricardo, Modesti Mikol, Patrikidou Anna, Pignata Sandro, Procopio Giuseppe, Fornarini Giuseppe, De Giorgi Ugo, Russo Antonio, Francini Edoardo
机构信息
Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
Department of Internal Medicine, University of Genoa, Genova, Italy.
出版信息
Ther Adv Med Oncol. 2023 Mar 3;15:17588359231156147. doi: 10.1177/17588359231156147. eCollection 2023.
BACKGROUND
Androgen receptor signaling inhibitors (ARSis) abiraterone acetate (AA) plus prednisone and enzalutamide (Enza), are currently the most administered first-line treatments for metastatic castration-resistant prostate cancer (mCRPC). AA and Enza have shown similar overall survival (OS) benefits and there is no consensus upon the best option for mCRPC first-line treatment. Volume of disease may represent a useful biomarker to predict response to therapy in such patients.
OBJECTIVES
In this study, we seek to evaluate the impact of volume of disease on patients treated with first-line AA Enza for mCRPC.
DESIGN AND METHODS
We retrospectively evaluated a cohort of consecutive patients with mCRPC categorized by volume of disease [high volume (HV) or low volume (LV) per E3805 criteria] at ARSi onset and treatment type (AA or Enza), assessing OS and radiographic progression-free survival (rPFS), from therapy start, as co-primary endpoints.
RESULTS
Of the 420 patients selected, 170 (40.5%) had LV and received AA (LV/AA), 76 (18.1%) LV and had Enza (LV/Enza), 124 (29.5%) HV and were given AA (HV/AA), and 50 (11.9%) HV and received Enza (HV/Enza). Among patients with LV, OS was significantly longer when treated with Enza [57.2 months; 95% confidence interval (CI): 52.1-62.2 months] AA (51.6 months; 95% CI, 42.6-60.6 months; = 0.003). Consistently, those with LV receiving Enza showed increased rPFS (40.3 months; 95 CI, 25.0-55.7 months) than those having AA (22.0 months; 95% CI, 18.1-26.0 months; = 0.004). No significant difference in OS or rPFS was observed in those with HV treated with AA Enza ( = 0.51 and = 0.73, respectively). In multivariate analysis of patients with LV, treatment with Enza was independently associated with better prognosis than AA.
CONCLUSION
Within the intrinsic limitations of a retrospective design and small population, our report suggests that volume of disease could be a useful predictive biomarker for patients starting first-line ARSi for mCRPC.
背景
雄激素受体信号抑制剂（ARSis）醋酸阿比特龙（AA）联合泼尼松以及恩杂鲁胺（Enza），目前是转移性去势抵抗性前列腺癌（mCRPC）最常用的一线治疗方案。AA和Enza显示出相似的总生存期（OS）获益，对于mCRPC一线治疗的最佳选择尚无共识。疾病体积可能是预测此类患者治疗反应的有用生物标志物。
目的
在本研究中，我们试图评估疾病体积对接受mCRPC一线AA或Enza治疗患者的影响。
设计与方法
我们回顾性评估了一组连续性mCRPC患者，根据ARSis开始时的疾病体积[按照E3805标准分为高体积（HV）或低体积（LV）]以及治疗类型（AA或Enza）进行分类，从治疗开始评估OS和影像学无进展生存期（rPFS），将其作为共同主要终点。
结果
在入选的420例患者中，170例（40.5%）为LV并接受AA治疗（LV/AA），76例（18.1%）为LV并接受Enza治疗（LV/Enza），124例（29.5%）为HV并接受AA治疗（HV/AA），50例（11.9%）为HV并接受Enza治疗（HV/Enza）。在LV患者中，接受Enza治疗时OS显著更长[57.2个月；95%置信区间（CI）：52.1 - 62.2个月]，而接受AA治疗时为51.6个月（95% CI，42.6 - 60.6个月；P = 0.003）。同样，接受Enza治疗的LV患者rPFS增加（40.3个月；95% CI，25.0 - 55.7个月），高于接受AA治疗的患者（22.0个月；95% CI，18.1 - 26.0个月；P = 0.004）。接受AA或Enza治疗的HV患者在OS或rPFS方面未观察到显著差异（分别为P = 0.51和P = 0.73）。在LV患者的多因素分析中，与AA相比，Enza治疗独立地与更好的预后相关。
结论
在回顾性设计和小样本量的固有局限性内，我们的报告表明疾病体积可能是开始mCRPC一线ARSis治疗患者的有用预测生物标志物。
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