Shimomura Tatsuya, Mori Keiichiro, Matsukawa Akihiro, Fukuokaya Wataru, Yanagisawa Takafumi, Urabe Fumihiko, Murakami Masaya, Miki Jun, Yamada Hiroki, Kimura Takahiro
Urology, Jikei University School of Medicine, Tokyo, JPN.
Cureus. 2024 Jul 10;16(7):e64217. doi: 10.7759/cureus.64217. eCollection 2024 Jul.
Purpose We recently released the multi-institutional real-world analysis about the difference in survival outcomes between abiraterone acetate and enzalutamide against chemo-naïve castration-resistant prostate cancer (CRPC) in a first-line setting. Although reduced dose induction cases were included in that analysis, induction dose reduction might correlate with reduced efficacy. In this study, we analyzed full-dose induction subgroups from our overall cohort and investigated the true difference in efficacy between these agents. Methods A total of 220 chemotherapy-naïve CRPC cases treated with full-dose induction of first-line androgen receptor signaling inhibitor (ARSI) were analyzed. Outcome measures were prostate-specific antigen (PSA) response, PSA progression-free survival (PSA-PFS), treatment failure-free survival (TFF), cancer-specific survival (CSS), and overall survival (OS). Results Abiraterone acetate and enzalutamide were administered to 58 and 162 patients, respectively. The median PSA response rate (-65.4% (A) and -81.5% (E), p = 0.0252), PSA decline ≥ 90% (22.4% (A) and 37.0% (E), p = 0.0478), PSA-PFS (median four months (A) and seven months (E), p = 0.00833), TFF (median six months (A) and 15 months (E), p<0.0001), CSS (median 45 months (A) and not reached (E), p < 0.0001), and OS (median 34 months (A) and 80 months (E), p<0.001) were significantly better in the E group. Conclusion This study showed that PSA response, PSA-PFS, TTF, CSS, and OS were better with first-line enzalutamide administration. Direct inhibition of androgen receptor signaling by enzalutamide is associated with better clinical outcomes in the full-dose induction cohort.
目的 我们最近发布了一项多机构真实世界分析，内容是关于醋酸阿比特龙和恩杂鲁胺在一线治疗初治去势抵抗性前列腺癌（CRPC）时生存结局的差异。尽管该分析纳入了剂量降低诱导的病例，但诱导剂量降低可能与疗效降低相关。在本研究中，我们分析了总体队列中的全剂量诱导亚组，并研究了这些药物之间疗效的真正差异。方法 总共分析了220例接受一线雄激素受体信号抑制剂（ARSI）全剂量诱导治疗的初治CRPC病例。观察指标为前列腺特异性抗原（PSA）反应、PSA无进展生存期（PSA-PFS）、无治疗失败生存期（TFF）、癌症特异性生存期（CSS）和总生存期（OS）。结果 分别有58例和162例患者接受了醋酸阿比特龙和恩杂鲁胺治疗。E组的中位PSA反应率（-65.4%（A）和-81.5%（E），p = 0.0252）、PSA下降≥90%（22.4%（A）和37.0%（E），p = 0.0478）、PSA-PFS（中位4个月（A）和7个月（E），p = 0.00833）、TFF（中位6个月（A）和15个月（E），p<0.0001）、CSS（中位45个月（A）和未达到（E），p < 0.0001）以及OS（中位34个月（A）和80个月（E），p<0.001）均显著更好。结论 本研究表明，一线使用恩杂鲁胺时，PSA反应、PSA-PFS、TTF、CSS和OS更佳。恩杂鲁胺对雄激素受体信号的直接抑制与全剂量诱导队列中更好的临床结局相关。
