Soomro Misbah Younus, Khan Saqib Raza, Ishfaq Hashim, Ali Insia, Samar Mirza Rameez, Hameed Arif, Zehra Nawazish, Moosajee Munira, Rashid Yasmin Abdul
Department of Oncology, Section of Medical Oncology, Aga Khan University Hospital, Sindh, Karachi 748000, Pakistan.
Aga Khan Medical College, Aga Khan University Hospital, Sindh, Karachi 748000, Pakistan.
Ecancermedicalscience. 2024 Sep 11;18:1763. doi: 10.3332/ecancer.2024.1763. eCollection 2024.
The management of metastatic prostate cancer has progressed immensely in the last decade. This study aims to investigate the real-world clinical outcomes of metastatic prostate adenocarcinoma treated with abiraterone and enzalutamide. The findings will assist healthcare providers in making more informed decisions when choosing between these two drugs for treating these patients.
A retrospective analysis of 80 patients at our tertiary care hospital was conducted from January 2015 to July 2022. Data were analysed using SPSS version 20.0. An independent sample -test was used for continuous data and the chi-square test for categorical data. Medians and means were calculated for continuous or ordinal variables. Kaplan-Meier survival curves presented progression-free and overall survival (OS), with comparisons made using the log-rank test. Survival rates with 95% CIs were reported, with < 0.05 considered significant.
In our final analysis of 80 patients, the median age was 65 years, with 88% having an eastern cooperative oncology group performance status between 0 and 2. Histopathology showed adenocarcinoma in 91% of cases. Grade Group III-IV disease was present in 51.3%, and 67.5% had a Gleason Score of >8. Bilateral orchidectomy was performed in 41 patients (51.25%), with a median Gonadotropin-releasing hormone analogue use of 32 months. Most patients (72.5%) were castration-sensitive. Among the 80 patients, 60 (75%) were treated with abiraterone and 20 (25%) with enzalutamide. The prostate-specific antigen (PSA) doubling time was >6 months in 80% of the abiraterone group and 75% of the enzalutamide group. PSA response rates were similar for both drugs, with comparable rates of progressive disease, partial response, stable disease and complete response ( = 0.036). There was no significant difference in median time to progression (19 months for abiraterone versus 18 months for enzalutamide) (95% CI 9.7-27.9; = 0.004). The median OS for the entire cohort was 67 months (95% CI 39-94; = 0.003).
The findings suggest that both abiraterone and enzalutamide are effective in prolonging progression-free and overall survival in this patient population, providing comparable safety. Further studies are recommended to validate these findings and inform clinical decision-making.
在过去十年中，转移性前列腺癌的治疗取得了巨大进展。本研究旨在调查使用阿比特龙和恩杂鲁胺治疗转移性前列腺腺癌的真实世界临床结局。这些发现将有助于医疗保健提供者在为这些患者选择这两种药物时做出更明智的决策。
对2015年1月至2022年7月在我们三级医疗中心的80例患者进行回顾性分析。使用SPSS 20.0版软件进行数据分析。连续数据采用独立样本t检验，分类数据采用卡方检验。计算连续或有序变量的中位数和均值。绘制Kaplan-Meier生存曲线以呈现无进展生存期和总生存期（OS），并使用对数秩检验进行比较。报告95%置信区间的生存率，P<0.05被认为具有统计学意义。
在对80例患者的最终分析中，中位年龄为65岁，88%的患者东部肿瘤协作组体能状态为0至2。组织病理学显示91%的病例为腺癌。51.3%的患者为Ⅲ-Ⅳ级疾病，67.5%的患者Gleason评分>8。41例患者（51.25%）接受了双侧睾丸切除术，促性腺激素释放激素类似物的中位使用时间为32个月。大多数患者（72.5%）对去势敏感。在这80例患者中，60例（75%）接受阿比特龙治疗，20例（25%）接受恩杂鲁胺治疗。阿比特龙组80%的患者和恩杂鲁胺组75%的患者前列腺特异性抗原（PSA）倍增时间>6个月。两种药物的PSA缓解率相似，疾病进展、部分缓解、疾病稳定和完全缓解率相当（P=0.036）。中位至疾病进展时间无显著差异（阿比特龙为19个月，恩杂鲁胺为18个月）（95%CI 9.7-27.9；P=0.004）。整个队列的中位总生存期为67个月（95%CI 39-94；P=0.003）。
研究结果表明，阿比特龙和恩杂鲁胺在延长该患者群体的无进展生存期和总生存期方面均有效，安全性相当。建议进一步研究以验证这些发现并为临床决策提供依据。
