Department of Medicine, University of Alberta, 11230-83 Ave NW, Edmonton, AB T6G 2B7, Canada.
Department of Medical Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada.
Curr Oncol. 2024 Aug 29;31(9):5080-5087. doi: 10.3390/curroncol31090375.
The management of advanced prostate cancer continues to evolve rapidly, particularly with the earlier use of survival-prolonging therapies in metastatic castration-sensitive prostate cancer (mCSPC). Though approved prior to the use of intensification therapy in mCSPC, taxane-based chemotherapies remain a relevant option for patients with metastatic castration-resistant prostate cancer (mCRPC). However, there is little evidence determining the outcomes of taxane chemotherapies as the first subsequent taxane (FST) in mCRPC pts who received docetaxel intensification (DI) in mCSPC. The purpose of this study is to compare outcomes between the survival-prolonging taxanes, docetaxel and cabazitaxel as FST after DI.
New patient consults seen at the Cross Cancer Institute from 1 July 2014 to 31 December 2020 were retrospectively reviewed. Pts were considered eligible if they received DI for mCSPC and then received either docetaxel or cabazitaxel in mCRPC. Variables of interest were collected from electronic medical records. The primary endpoint was ≥50% PSA response at 12 weeks relative to baseline for FST. Secondary endpoints included OS from mCSPC diagnosis, as well as PFS and OS from the FST start date. PSA responses were compared using the chi-squared test, and time-based endpoints were compared using the Kaplan-Meier method.
In total, 34 pts were identified: docetaxel = 22 and cabazitaxel = 12 as FST. 91.2% of pts (docetaxel 95.5% vs. cabazitaxel 83.3%) received FST in 2nd line mCRPC. The median age at diagnosis (63.1 vs. 67.1 yrs, = 0.236) and the median time to CRPC (18.6 vs. 14.2 mos, = 0.079) were similar for docetaxel and cabazitaxel, respectively. The median time to FST (24.1 vs. 34.6 mos, = 0.036) and OS from mCSPC diagnosis (30.9 vs. 52.7 mos, = 0.002) were significantly shorter for pts receiving cabazitaxel vs. docetaxel. PSA responses occurred in 40.9% of pts treated with docetaxel compared to 25.0% treated with cabazitaxel ( = 0.645). There was no significant difference in median PFS (2.7 vs. 3.5 mos, = 0.727) or median OS (11.4 vs. 8.1 mos, = 0.132) from the time of FST for pts treated with docetaxel vs. cabazitaxel, respectively.
Both docetaxel and cabazitaxel demonstrated activity as FST after DI in mCSPC. Pts who received cabazitaxel had a shorter time to FST and OS from mCSPC. The reasons for this may reflect clinician preference for cabazitaxel in pts with aggressive or rapidly progressing disease. No difference was found in PSA response, PFS, or OS from FST with docetaxel compared to cabazitaxel. While limited by its retrospective nature and small sample size, this study suggests that docetaxel is active as FST despite treatment with DI in mCSPC.
晚期前列腺癌的治疗仍在迅速发展，尤其是在转移性去势敏感前列腺癌（mCSPC）中更早地使用延长生存的疗法。尽管在 mCSPC 中强化治疗之前已批准使用，但基于紫杉烷的化疗在转移性去势抵抗性前列腺癌（mCRPC）患者中仍然是一种相关的选择。然而，在 mCSPC 中接受多西紫杉醇强化治疗（DI）的患者中，作为 FST 的紫杉烷化疗的结果很少有证据确定，其目的是比较在 mCSPC 中接受 DI 治疗后作为 FST 的生存延长紫杉烷，多西紫杉醇和卡巴他赛的疗效。
从 2014 年 7 月 1 日至 2020 年 12 月 31 日，回顾性审查了在 Cross Cancer Institute 就诊的新患者咨询情况。如果患者接受 mCSPC 的 DI 治疗，然后在 mCRPC 中接受多西紫杉醇或卡巴他赛治疗，则认为符合条件。从电子病历中收集感兴趣的变量。主要终点是 FST 相对于基线的 12 周时 PSA 反应≥50%。次要终点包括从 mCSPC 诊断开始的 OS，以及从 FST 开始日期开始的 PFS 和 OS。使用卡方检验比较 PSA 反应，使用 Kaplan-Meier 方法比较基于时间的终点。
共确定了 34 例患者：多西紫杉醇= 22 例，卡巴他赛= 12 例作为 FST。91.2%（多西紫杉醇 95.5%vs.卡巴他赛 83.3%）的患者在二线 mCRPC 中接受了 FST。多西紫杉醇和卡巴他赛的患者诊断时的中位年龄（63.1 岁 vs. 67.1 岁， = 0.236）和至 CRPC 的中位时间（18.6 个月 vs. 14.2 个月， = 0.079）相似。FST 的中位时间（24.1 个月 vs. 34.6 个月， = 0.036）和从 mCSPC 诊断开始的 OS（30.9 个月 vs. 52.7 个月， = 0.002）在接受卡巴他赛治疗的患者中明显更短，而在接受多西紫杉醇治疗的患者中，PSA 反应发生在 40.9%的患者中，而在接受卡巴他赛治疗的患者中，PSA 反应发生在 25.0%的患者中（ = 0.645）。接受多西紫杉醇治疗的患者的中位 PFS（2.7 个月 vs. 3.5 个月， = 0.727）和 OS（11.4 个月 vs. 8.1 个月， = 0.132）均无显着差异从 FST 开始的时间，与接受卡巴他赛治疗的患者相比。
多西紫杉醇和卡巴他赛在 mCSPC 中接受 DI 治疗后均显示出作为 FST 的活性。接受卡巴他赛治疗的患者 FST 和从 mCSPC 开始的 OS 时间更短。其原因可能反映了在疾病侵袭性或快速进展的患者中，临床医生对卡巴他赛的偏好。与卡巴他赛相比，多西紫杉醇作为 FST 的 PSA 反应，PFS 或 OS 没有差异。尽管受其回顾性性质和样本量小的限制，但本研究表明，多西紫杉醇在 mCSPC 中接受 DI 治疗后仍然具有活性。
