阿帕鲁胺与立体定向体部放疗用于转移性激素敏感性前列腺癌：多中心真实世界研究

Apalutamide and Stereotactic Body Radiotherapy in Metastatic Hormone-Sensitive Prostate Cancer: Multicenter Real-World Study.

作者信息

Encarnación Juan A, Morillo Macías Virginia, De la Fuente Muñoz Isabel, Soria Violeta Derrac, Fernández Fornos Luis, Antequera María Albert, Rey Osamah Amr, García Martínez Vicente, Alonso-Romero José L, García Gómez Raquel

机构信息

Department Radiation Oncology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain.

Faculty of Medicine, University of Murcia, 30100 Murcia, Spain.

出版信息

Cancers (Basel). 2025 Jul 2;17(13):2216. doi: 10.3390/cancers17132216.

DOI:10.3390/cancers17132216

PMID:40647514

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12249003/

Abstract

BACKGROUND

The management of metastatic hormone-sensitive prostate cancer (mHSPC) has evolved with the integration of androgen receptor signaling inhibitors (ARSIs) and metastasis-directed therapies (MDTs). Stereotactic body radiotherapy (SBRT) offers precise local control, yet real-world data on its combination with apalutamide remain limited.

METHODS

We conducted a multicenter retrospective cohort study including 134 patients with mHSPC treated with apalutamide and SBRT between February 2021 and December 2024. The primary endpoints were progression-free survival (PFS), local control (LC), and treatment safety. PSA kinetics and radiologic response were evaluated, and outcomes were analyzed according to PSA thresholds and treatment timing.

RESULTS

Most patients (93.3%) had low-volume disease; 97.1% presented with ≤5 metastases. At a median follow-up of 28 months, LC was 99.3% and 95.5% of patients were progression-free. Complete radiological response was achieved in 87.5% of patients, and 68.4% attained ultralow PSA levels (≤0.02 ng/mL). Undetectable PSA and radiologic complete response were independently associated with improved PFS ( = 0.010 and = 0.011, respectively). Treatment was well tolerated, with grade ≥3 toxicity occurring in only 2.2% of patients.

CONCLUSIONS

The combination of apalutamide and SBRT in mHSPC is associated with high local and systemic disease control and minimal toxicity in a real-world setting. This approach may delay systemic treatment intensification and the onset of castration resistance. Prospective studies are warranted to confirm these findings.

摘要

背景

随着雄激素受体信号抑制剂（ARSIs）和转移导向治疗（MDTs）的整合，转移性激素敏感性前列腺癌（mHSPC）的管理发生了演变。立体定向体部放疗（SBRT）可提供精确的局部控制，但关于其与阿帕鲁胺联合应用的真实世界数据仍然有限。

方法

我们进行了一项多中心回顾性队列研究，纳入了2021年2月至2024年12月期间接受阿帕鲁胺和SBRT治疗的134例mHSPC患者。主要终点为无进展生存期（PFS）、局部控制（LC）和治疗安全性。评估了前列腺特异性抗原（PSA）动力学和影像学反应，并根据PSA阈值和治疗时机分析了结果。

结果

大多数患者（93.3%）疾病体积较小；97.1%的患者出现≤5处转移。中位随访28个月时，LC率为99.3%，95.5%的患者无进展。87.5%的患者实现了完全影像学缓解，68.4%的患者达到超低PSA水平（≤0.02 ng/mL）。PSA不可检测和影像学完全缓解与PFS改善独立相关（分别为 = 0.010和 = 0.011）。治疗耐受性良好，仅2.2%的患者出现≥3级毒性。