Kikkawa Kazuro, Tamaki Masahiro, Maruno Kouhei, Hazama Tatsuya, Takahashi Toshifumi, Yamada Yuya, Nakashima Masakazu, Ito Noriyuki
Department of Urology Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubaradori, Wakayama 640-8558, Japan.
Prostate Cancer. 2024 Aug 5;2024:9303603. doi: 10.1155/2024/9303603. eCollection 2024.
This study evaluated the effects of docetaxel and androgen receptor signaling inhibitors as second-line treatments in patients with castration-resistant prostate cancer after androgen receptor signaling inhibitors as first-line treatment. This study retrospectively evaluated the clinical outcomes of second-line treatment with docetaxel or androgen receptor signaling inhibitor in patients with castration-resistant prostate cancer who received first-line treatment with androgen receptor signaling inhibitors. Clinical backgrounds and outcomes were compared between docetaxel and androgen receptor signaling inhibitors as second-line treatment. Of 59 patients, 21 (35.6%) and 38 (64.4%) received docetaxel and androgen receptor signaling inhibitors as second-line treatment after first-line treatment with androgen receptor signaling inhibitors, respectively. In the second-line setting, the median progression-free survival was longer with androgen receptor signaling inhibitor than with docetaxel (17 versus 6 months, =0.014). In the first-line setting, the median progression-free survival was longer with androgen receptor signaling inhibitors than with docetaxel (32 versus 25 months, =0.014); however, no significant difference was found in the overall survival. Multivariate analysis revealed that there was no significant association between second-line treatment and survival, and first-line treatment with abiraterone was identified as a prognostic factor for progression-free survival. Subgroup analysis showed that the abiraterone-enzalutamide sequence was more effective than the other three sequences for progression-free survival and overall survival. This study suggests that second-line treatment with an androgen receptor signaling inhibitor for castration-resistant prostate cancer after androgen receptor signaling inhibitors as first-line treatment may be more beneficial, particularly with abiraterone as the upfront treatment.
本研究评估了多西他赛和雄激素受体信号抑制剂作为一线治疗为雄激素受体信号抑制剂的去势抵抗性前列腺癌患者二线治疗的效果。本研究回顾性评估了接受雄激素受体信号抑制剂一线治疗的去势抵抗性前列腺癌患者使用多西他赛或雄激素受体信号抑制剂进行二线治疗的临床结局。比较了多西他赛和雄激素受体信号抑制剂作为二线治疗的临床背景和结局。59例患者中，分别有21例（35.6%）和38例（64.4%）在接受雄激素受体信号抑制剂一线治疗后接受多西他赛和雄激素受体信号抑制剂作为二线治疗。在二线治疗中，雄激素受体信号抑制剂组的无进展生存期长于多西他赛组（17个月对6个月，P=0.014）。在一线治疗中，雄激素受体信号抑制剂组的无进展生存期长于多西他赛组（32个月对25个月，P=0.014）；然而，总生存期未发现显著差异。多变量分析显示二线治疗与生存之间无显著关联，且阿比特龙一线治疗被确定为无进展生存期的预后因素。亚组分析表明，阿比特龙-恩杂鲁胺序贯治疗在无进展生存期和总生存期方面比其他三种序贯治疗更有效。本研究表明，对于一线治疗为雄激素受体信号抑制剂的去势抵抗性前列腺癌患者，使用雄激素受体信号抑制剂进行二线治疗可能更有益，尤其是将阿比特龙作为初始治疗时。
