University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA.
Prostate Cancer Foundation, Santa Monica, California, USA.
Prostate. 2023 Sep;83(13):1279-1284. doi: 10.1002/pros.24589. Epub 2023 Jun 19.
Abiraterone and concurrent androgen deprivation therapy (ADT) are used in the treatment of patients with metastatic castration-resistant prostate cancer. Recently, it has been suggested that the use of abiraterone alone (without ADT) may have comparable efficacy to abiraterone with ongoing ADT. Here, we sought to assess the impact of ADT cessation in patients beginning abiraterone for castration-resistant prostate cancer.
We identified 39 patients at our institution who received abiraterone alone (with discontinuation of ADT) between 2011 and 2022. We then procured a comparable group of 39 patients (matched by age, Gleason score, and prostate-specific antigen [PSA] level) who received abiraterone with ongoing ADT during the same period. We assessed and compared clinical outcomes in the two groups (abiraterone-alone vs. abiraterone-ADT) with respect to PSA response rates, PSA progression-free survival, and overall survival. Results were adjusted using Cox proportional-hazards multivariable models.
The median PSA before treatment initiation was 12.7 (range: 0.2-199) ng/mL in the abiraterone-alone group and 15.5 (range: 0.6-212) ng/mL in the abiraterone-ADT group. Use of abiraterone alone adequately suppressed testosterone levels in 35/37 (94.6%) patients. Patients receiving abiraterone alone had a median PSA reduction of 80.2% versus 79.5% in patients receiving abiraterone plus ADT. The median PSA progression-free survival in patients receiving abiraterone alone was 27.4 versus 25.8 months in patients receiving abiraterone plus ADT (hazard ratio [HR] 1.10; 95% confidence interval [CI] 0.65-1.71; p = 0.82). In addition, abiraterone alone was associated with an overall survival of 3.6 versus 3.1 years in patients receiving abiraterone plus ADT (HR 0.90; 95% CI 0.50-1.62; p = 0.72). There were no differences in PFS or OS between groups after performing Cox multivariable regression analyses.
Use of abiraterone alone was associated with comparable clinical outcomes to patients who received abiraterone together with ADT. Further prospective studies are warranted to evaluate the impact of abiraterone alone on treatment outcomes and cost savings.
阿比特龙联合雄激素剥夺疗法（ADT）被用于治疗转移性去势抵抗性前列腺癌患者。最近有研究表明，单独使用阿比特龙（不联合 ADT）可能与阿比特龙联合 ADT 具有相当的疗效。在此，我们旨在评估在开始使用阿比特龙治疗去势抵抗性前列腺癌的患者中停止 ADT 的影响。
我们在本院确定了 39 名在 2011 年至 2022 年间单独接受阿比特龙（联合 ADT 停药）治疗的患者。然后，我们招募了一组 39 名在同期接受联合 ADT 治疗的患者（按年龄、Gleason 评分和前列腺特异性抗原[PSA]水平匹配）。我们评估了两组（单独使用阿比特龙与阿比特龙联合 ADT）的 PSA 反应率、PSA 无进展生存期和总生存期等临床结局，并进行了比较。结果采用 Cox 比例风险多变量模型进行调整。
单独使用阿比特龙组的 PSA 基线值为 12.7（范围：0.2-199）ng/mL，阿比特龙联合 ADT 组的 PSA 基线值为 15.5（范围：0.6-212）ng/mL。37 例（94.6%）患者单独使用阿比特龙可充分抑制睾酮水平。单独使用阿比特龙的患者 PSA 降低 80.2%，而联合 ADT 的患者 PSA 降低 79.5%。单独使用阿比特龙的患者 PSA 无进展生存期为 27.4 个月，联合 ADT 的患者为 25.8 个月（风险比[HR]为 1.10；95%置信区间[CI]为 0.65-1.71；p=0.82）。此外，单独使用阿比特龙的患者总生存期为 3.6 年，而联合 ADT 的患者为 3.1 年（HR 为 0.90；95%CI 为 0.50-1.62；p=0.72）。进行 Cox 多变量回归分析后，两组之间在 PFS 或 OS 方面无差异。
单独使用阿比特龙与接受阿比特龙联合 ADT 的患者的临床结局相当。需要进一步的前瞻性研究来评估单独使用阿比特龙对治疗结局和成本节约的影响。
