Small E J, Srinivas S
Department of Medicine, University of California, San Francisco, Mt Zion/UCSF Cancer Center 94115, USA.
Cancer. 1995 Oct 15;76(8):1428-34. doi: 10.1002/1097-0142(19951015)76:8<1428::aid-cncr2820760820>3.0.co;2-t.
Flutamide withdrawal has been reported to be therapeutically efficacious for patients with hormone-refractory prostate cancer, with a reported prostate specific antigen (PSA) response rate of 29%.
to evaluate the results of flutamide withdrawal in a large group of unselected patients, the medical records of 107 consecutive patients with metastatic prostate cancer who developed progressive disease while receiving flutamide therapy were reviewed retrospectively. Flutamide withdrawal was undertaken at the time of disease progression.
Eighty-two patients were evaluable. Of these, three had a > 80% fall in PSA value, and another nine had a > 50% decrease, for a response proportion of 14.6% (95% confidence interval 7.8%-24.2%). The median response duration was 3.5 months (range, 1-12+ months). Eight of patients treated with combined androgen blockade at the time of diagnosis of metastatic disease had a response (14%), whereas 4/25 responses (16%) were noted in patients in whom flutamide was added later, at the time of first progression. When patients who responded were compared with patients who did not respond, there was not a significant difference in age, pretreatment PSA level, type of gonadal androgen deprivation, or the likelihood of prior combined androgen blockade versus late addition of flutamide. The duration of prior therapy with flutamide was longer in patients who responded (21.5 vs. 12.0 months).
These findings confirm the flutamide withdrawal phenomenon in a large group of unselected patients, although its frequency is not as high as previously reported. In contrast to earlier reports, whether patients have had initial hormonal therapy with combined androgen blockade or monotherapy does not appear to be predictive of the likelihood of response to antiandrogen withdrawal.
据报道，氟他胺撤药对激素难治性前列腺癌患者具有治疗效果，前列腺特异性抗原（PSA）反应率为29%。
为了评估在一大组未经选择的患者中氟他胺撤药的结果，回顾性分析了107例接受氟他胺治疗期间出现疾病进展的转移性前列腺癌患者的病历。在疾病进展时进行氟他胺撤药。
82例患者可评估。其中，3例PSA值下降超过80%，另外9例下降超过50%，反应比例为14.6%（95%置信区间7.8%-24.2%）。中位反应持续时间为3.5个月（范围1-12+个月）。在转移性疾病诊断时接受联合雄激素阻断治疗的患者中有8例有反应（14%），而在首次进展时后来添加氟他胺的患者中有4/25例有反应（16%）。将有反应的患者与无反应的患者进行比较时，在年龄、治疗前PSA水平、性腺雄激素剥夺类型或先前联合雄激素阻断与后期添加氟他胺的可能性方面没有显著差异。有反应的患者先前使用氟他胺治疗的持续时间更长（21.5个月对12.0个月）。
这些发现证实了在一大组未经选择的患者中存在氟他胺撤药现象，尽管其频率不如先前报道的高。与早期报告相反，患者最初是否接受联合雄激素阻断或单药激素治疗似乎不能预测对抗雄激素撤药反应的可能性。
