Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Cancer Risk Factors and Lifestyle Epidemiology Unit - ISPRO, Florence, Italy.
Clin Genitourin Cancer. 2024 Oct;22(5):102185. doi: 10.1016/j.clgc.2024.102185. Epub 2024 Aug 9.
Managing metastatic castration-resistant prostate cancer (mCRPC) in men aged ≥ 75 is challenging due to limited data. Regardless of age, in real-world clinical practice, most mCRPC still derive from failure of androgen deprivation therapy (ADT) with or without docetaxel (D) for metastatic castration-sensitive prostate cancer (mCSPC). As abiraterone acetate plus prednisone (AA) and enzalutamide (Enza) are common first-line treatments for mCRPC. The impact of prior use of D for mCSPC on the efficacy and safety of AA or Enza in this older population remains unclear.
A cohort of patients aged ≥ 75 years starting AA or Enza as first-line therapy for mCRPC from January 2015 to April 2019 was identified from the registries of 10 institutions. Patients were categorized into 2 groups based on previous use of D for mCSPC. Primary endpoints were cancer-specific survival (CSS) from AA or Enza start, CSS from ADT onset, and safety. We used Kaplan-Meier method to estimate the endpoints distribution, including median values with 95% confidence intervals (95% CI).
Of the 337 patients identified, 24 (7.1%) received ADT+D and 313 (92.9%) received ADT alone for mCSPC. Median follow-up from AA/Enza start was 18.8 months. Median CSS from ADT or AA/Enza was not significantly different between ADT+D and ADT alone cohorts (71.9 vs. 52.7 months, P = .97; 25.4 vs. 27.2 months, P = .89, respectively). No statistically significant difference in adverse events (AEs) of any grade rate (58.3% vs. 52.1%, respectively; P = .67) or grade ≥ 3 (12.5% vs. 15.7%, respectively; P = 1.0) was found between ADT+D and ADT alone cohorts.
Despite the innate limitations of a retrospective design and relatively small size of the ADT+D cohort, this analysis suggests that elderly men receiving AA or Enza as first-line therapy for mCRPC have similar survival outcomes and tolerability, regardless of previous D for mCSPC.
由于数据有限，管理年龄≥75 岁的转移性去势抵抗性前列腺癌（mCRPC）具有挑战性。无论年龄大小，在真实临床实践中，大多数 mCRPC 仍源于去势敏感前列腺癌（mCSPC）失败的雄激素剥夺治疗（ADT）加或不加多西他赛（D）。阿比特龙联合泼尼松（AA）和恩扎鲁胺（Enza）是 mCRPC 的常见一线治疗药物。在这个老年人群中，先前使用 D 治疗 mCSPC 对 AA 或 Enza 的疗效和安全性的影响尚不清楚。
从 2015 年 1 月至 2019 年 4 月，从 10 家机构的登记处确定了年龄≥75 岁的开始接受 AA 或 Enza 一线治疗 mCRPC 的患者队列。根据先前使用 D 治疗 mCSPC 的情况，将患者分为 2 组。主要终点是从 AA 或 Enza 开始的癌症特异性生存（CSS）、从 ADT 开始的 CSS 和安全性。我们使用 Kaplan-Meier 法估计终点分布，包括中位数及其 95%置信区间（95%CI）。
在确定的 337 名患者中，24 名（7.1%）接受 ADT+D，313 名（92.9%）接受 ADT 单独治疗 mCSPC。从 AA/Enza 开始的中位随访时间为 18.8 个月。ADT+D 和 ADT 单独组的 ADT 或 AA/Enza 的中位 CSS 无显著差异（71.9 与 52.7 个月，P=1.0；25.4 与 27.2 个月，P=1.0）。ADT+D 和 ADT 单独组的任何等级不良事件（AE）发生率（分别为 58.3%与 52.1%，P=1.0；分别为 12.5%与 15.7%，P=1.0）或≥3 级（分别为 12.5%与 15.7%，P=1.0）无统计学差异。
尽管存在回顾性设计的固有局限性和 ADT+D 队列相对较小，但这项分析表明，接受 AA 或 Enza 作为一线治疗 mCRPC 的老年男性具有相似的生存结果和耐受性，无论先前是否使用 D 治疗 mCSPC。
