Büttner Thomas, Lossin Philipp, Latz Stefan, Jacobs Carolin, Krausewitz Philipp, Hauser Stefan
Department of Urology and Paediatric Urology University Hospital Bonn Bonn Germany.
Urologie Bonn Rhein-Sieg Bonn Germany.
Aging Med (Milton). 2024 Dec 19;7(6):761-769. doi: 10.1002/agm2.12372. eCollection 2024 Dec.
Attaining castration resistance in metastatic prostate cancer (mCRPC) represents a pivotal juncture in the progression of the patient's illness and treatment regimen. Within this therapeutic context, novel hormonal agents (NHA) constitute a fundamental component of pharmacological intervention. However, the efficacy of NHA therapy remains uncertain for patients with a compromised general condition, as indicated by an Eastern Cooperative Oncology Group Performance Status (ECOG PS) score of ≥2. Notably, most clinical trials excluded individuals with an ECOG PS ≥2, leaving a gap in our understanding of the potential benefits of NHA therapy for this specific patient cohort.
We conducted an analysis of fifty-three NHA-naïve men characterized by attaining mCRPC at an ECOG PS of ≥2 subsequent to androgen deprivation monotherapy between 2008 and 2023. Patients were then treated with either NHA or Best Supportive Care (BSC) based on individual decisions. Survival and adverse event (AE) analysis was performed to assess the outcomes of NHA therapy compared to BSC.
Among the patients, 30 (56.6%) received NHA, whereas the remaining 23 (43.4%) choose BSC. No significant differences in baseline characteristics were observed between the NHA and BSC group. Median overall survival (OS) was 9.1 months in the BSC group and 7.0 months in the NHA group, with no significant OS benefits associated with NHA treatment. AEs and severe AEs commonly occurred, but remained indifferent between treatment groups.
Our findings suggest that NHA therapy may confer reduced survival benefits in mCRPC patients with ECOG PS ≥2. While hope for NHA treatment persists, particularly given its oral administration and tolerability, careful consideration and discussion with patients regarding treatment expectations and palliative care goals are warranted in this challenging patient population.
在转移性前列腺癌（mCRPC）中实现去势抵抗是患者病情进展和治疗方案中的一个关键节点。在此治疗背景下，新型激素药物（NHA）是药物干预的一个基本组成部分。然而，对于一般状况较差（东部肿瘤协作组体能状态[ECOG PS]评分≥2）的患者，NHA治疗的疗效仍不确定。值得注意的是，大多数临床试验排除了ECOG PS≥2的个体，这使得我们对NHA治疗对这一特定患者群体潜在益处的理解存在空白。
我们对2008年至2023年间在雄激素剥夺单药治疗后以ECOG PS≥2达到mCRPC为特征的53名未接受过NHA治疗的男性进行了分析。然后根据个体决策，患者接受NHA或最佳支持治疗（BSC）。进行生存和不良事件（AE）分析，以评估NHA治疗与BSC相比的结果。
在患者中，30名（56.6%）接受了NHA治疗，而其余23名（43.4%）选择了BSC。NHA组和BSC组之间在基线特征方面未观察到显著差异。BSC组的中位总生存期（OS）为9.1个月，NHA组为7.0个月，NHA治疗未带来显著的OS益处。AE和严重AE常见，但治疗组之间无差异。
我们的研究结果表明，NHA治疗可能使ECOG PS≥2的mCRPC患者的生存获益降低。虽然对NHA治疗仍抱有希望，特别是考虑到其口服给药方式和耐受性，但对于这一具有挑战性的患者群体，有必要与患者仔细考虑并讨论治疗期望和姑息治疗目标。
