Zhang Zhiyu, Yu Yanhang, Zhang Chuanao, Zhang Jianglei, Zhang Xuefeng, Ouyang Jun
Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Oncol. 2025 Aug 15;15:1608786. doi: 10.3389/fonc.2025.1608786. eCollection 2025.
This study aimed to evaluate the therapeutic efficacy and adverse effects of combining enzalutamide with docetaxel versus using docetaxel alone in treating metastatic castration-resistant prostate cancer (mCRPC) that progresses after treatment with abiraterone followed by enzalutamide.
A retrospective analysis involved 67 mCRPC patients at the First Affiliated Hospital of Soochow University's Urology Department between October 2021 and August 2023. All experienced disease progression after treatment with abiraterone and enzalutamide. Patients were either in the study group, receiving enzalutamide and docetaxel, or in the control group, treated with docetaxel alone. Prostate-specific antigen (PSA) levels, imaging changes, and common adverse reactions were compared.
The study group showed a more significant reduction in PSA levels (≥50%) and improved outcomes in bone and lymph node metastases than the control group (P < 0.05). The median PSA progression-free survival (PFS) was longer for the study group at 193 days (95% CI: 174-207) versus 127 days (95% CI: 114-160) for the control group. Similarly, the median PFS for bone metastases was 271 days (95% CI: 265-274) in the study group, compared to 185 days (95% CI: 183-265) in the control group. For lymph node metastases, PFS was 265 days (95% CI: 194-274) versus 183 days (95% CI: 180-189), respectively, all statistically significant (P < 0.05). Visual analog scale scores decreased significantly post-treatment in both groups (P < 0.05), with more pronounced pain relief in the study group; median scores were 2 (IQR, 1-3) versus 3 (IQR, 3-5; P < 0.05). No Grade 3 or higher adverse reactions occurred, although the study group had more malaise, lumbago, and backache (P < 0.05). There were no significant differences in myelosuppression, gastrointestinal issues, liver dysfunction, neurological symptoms, edema, rash, or high blood pressure between groups (P > 0.05).
Combining enzalutamide with docetaxel is more effective than docetaxel alone for treating mCRPC after abiraterone and enzalutamide, providing better PSA-PFS and improved metastasis outcomes, along with better pain relief. Though the combination resulted in more adverse effects, no severe reactions (Grade 3 or higher) were observed, indicating good tolerability and clinical potential.
本研究旨在评估恩杂鲁胺联合多西他赛与单纯使用多西他赛治疗在接受阿比特龙治疗后进展且后续接受恩杂鲁胺治疗的转移性去势抵抗性前列腺癌（mCRPC）的疗效及不良反应。
一项回顾性分析纳入了2021年10月至2023年8月期间苏州大学第一附属医院泌尿外科的67例mCRPC患者。所有患者在接受阿比特龙和恩杂鲁胺治疗后均出现疾病进展。患者分为研究组（接受恩杂鲁胺和多西他赛治疗）和对照组（单纯接受多西他赛治疗）。比较两组患者的前列腺特异性抗原（PSA）水平、影像学变化及常见不良反应。
研究组的PSA水平降低更为显著（≥50%），且在骨转移和淋巴结转移方面的治疗效果优于对照组（P<0.05）。研究组的PSA无进展生存期（PFS）中位数为193天（95%CI：174 - 207），长于对照组的127天（95%CI：114 - 160）。同样，研究组骨转移的PFS中位数为271天（95%CI：265 - 274），对照组为185天（95%CI：183 - 265）。对于淋巴结转移，PFS分别为265天（95%CI：194 - 274）和183天（95%CI：180 - 189），均具有统计学意义（P<0.05）。两组治疗后视觉模拟评分均显著降低（P<0.05），研究组疼痛缓解更明显；中位数评分分别为2（IQR，1 - 3）和3（IQR，3 - 5；P<0.05）。尽管研究组有更多的不适、腰痛和背痛（P<0.05），但未发生3级或更高等级的不良反应。两组在骨髓抑制、胃肠道问题、肝功能障碍、神经症状、水肿、皮疹或高血压方面无显著差异（P>0.05）。
对于在接受阿比特龙和恩杂鲁胺治疗后的mCRPC，恩杂鲁胺联合多西他赛比单纯使用多西他赛更有效，能提供更好的PSA - PFS并改善转移灶的治疗效果，同时疼痛缓解更佳。尽管联合治疗导致更多不良反应，但未观察到严重反应（3级或更高），表明耐受性良好且具有临床应用潜力。
