Comparative effectiveness of androgen receptor pathway inhibitor treatment intensification for metastatic hormone-sensitive prostate cancer in real-world patients.

IF 2.9 3区医学 Q2 UROLOGY & NEPHROLOGY

Investigative and Clinical Urology Pub Date : 2025-11-01 DOI:10.4111/icu.20250313

Chan Ho Lee, Soodong Kim, Ja Yoon Ku, Kyung Hwan Kim, Byeong Jin Kang, Hyeok Jun Goh, Won Ik Seo, Hong Koo Ha

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Abstract

Purpose: This study compared the real-world effectiveness of androgen receptor pathway inhibitors (ARPIs)-abiraterone acetate, apalutamide, and enzalutamide-as treatment intensification in patients with metastatic hormone-sensitive prostate cancer (mHSPC).

Materials and methods: This multicenter retrospective cohort study analyzed 219 patients with mHSPC who received first-line ARPIs combined with androgen deprivation therapy. We evaluated progression-free survival to metastatic castration-resistant prostate cancer (PFS to mCRPC) and prostate-specific antigen (PSA) response within 12 weeks and investigated the prognostic impact of early PSA response on clinical outcomes.

Results: The cohort comprised patients receiving abiraterone acetate (n=94, 42.9%), apalutamide (n=91, 41.6%), and enzalutamide (n=34, 15.5%) with an 18.8-month median follow-up. The 2-year PFS to mCRPC rates demonstrated no significant difference between the groups (abiraterone acetate: 74.1%; apalutamide, 81.4%; enzalutamide, 85.6%; p=0.482). However, apalutamide and enzalutamide achieved superior rates of PSA decline to ≤0.2 ng/mL within 12 weeks compared with abiraterone acetate (44.0% and 55.9% vs. 25.5%, respectively) and significantly shorter median time to PSA nadir (7.2 and 7.5 months vs. 12.2 months; p<0.001). A PSA reduction of ≥90% within 12 weeks was observed in 87.2%, 94.5%, and 97.1% of patients receiving abiraterone acetate, apalutamide, and enzalutamide, respectively. Multivariate analysis identified early PSA response as an independent prognostic factor for improved PFS to mCRPC regardless of ARPI selection.

Conclusions: Abiraterone acetate, apalutamide, and enzalutamide showed comparable PFS to mCRPC outcomes, while significant differences in early PSA kinetics were observed, with early PSA response serving as a crucial prognostic factor in mHSPC patients.

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雄激素受体途径抑制剂强化治疗转移性激素敏感前列腺癌在现实世界患者中的比较效果。

目的：本研究比较了雄激素受体途径抑制剂（arpi）——醋酸阿比特龙、阿帕鲁胺和恩杂鲁胺——作为转移性激素敏感性前列腺癌（mHSPC）患者强化治疗的实际效果。材料和方法：这项多中心回顾性队列研究分析了219例接受一线arpi联合雄激素剥夺治疗的mHSPC患者。我们评估了12周内转移性去势抵抗性前列腺癌（PFS to mCRPC）的无进展生存期和前列腺特异性抗原（PSA）反应，并研究了早期PSA反应对临床结果的预后影响。结果：该队列包括接受醋酸阿比特龙（n=94, 42.9%）、阿帕鲁胺（n=91, 41.6%）和恩杂鲁胺（n=34, 15.5%）治疗的患者，中位随访时间为18.8个月。2年PFS与mCRPC的比值各组间无显著差异（醋酸阿比特龙74.1%，阿帕鲁胺81.4%，恩杂鲁胺85.6%,p=0.482）。然而，与醋酸阿比特龙相比，阿帕鲁胺和恩扎鲁胺在12周内的PSA下降率达到≤0.2 ng/mL（分别为44.0%和55.9%，分别为25.5%），并且达到PSA最低点的中位时间显著缩短(7.2和7.5个月，分别为12.2个月；结论：醋酸阿比特龙、阿帕鲁胺和恩扎鲁胺的PFS与mCRPC结果相当，但观察到早期PSA动力学存在显著差异，早期PSA反应是mHSPC患者的关键预后因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Investigative and Clinical Urology Medicine-Urology

CiteScore

4.10

自引率

4.30%

发文量

审稿时长

4 weeks

期刊介绍： Investigative and Clinical Urology (Investig Clin Urol, ICUrology) is an international, peer-reviewed, platinum open access journal published bimonthly. ICUrology aims to provide outstanding scientific and clinical research articles, that will advance knowledge and understanding of urological diseases and current therapeutic treatments. ICUrology publishes Original Articles, Rapid Communications, Review Articles, Special Articles, Innovations in Urology, Editorials, and Letters to the Editor, with a focus on the following areas of expertise: • Precision Medicine in Urology • Urological Oncology • Robotics/Laparoscopy • Endourology/Urolithiasis • Lower Urinary Tract Dysfunction • Female Urology • Sexual Dysfunction/Infertility • Infection/Inflammation • Reconstruction/Transplantation • Geriatric Urology • Pediatric Urology • Basic/Translational Research One of the notable features of ICUrology is the application of multimedia platforms facilitating easy-to-access online video clips of newly developed surgical techniques from the journal''s website, by a QR (quick response) code located in the article, or via YouTube. ICUrology provides current and highly relevant knowledge to a broad audience at the cutting edge of urological research and clinical practice.