Where Should Enzalutamide Be in The Metastatic Castration Resistant Prostate Cancer (mCRPC): A Multi-center Study

S. Koca
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引用次数: 0

Abstract

Objectives: Enzalutamide(ENZ) is an effective hormonal treatment modality in mCRPC. It can be used before or after docetaxel(DTX) in this setting. Herein, we aimed to show the efficacy of ENZ before or after DTX use and the factors predicting the efficacy. Methods: We retrospectively collected the data of 320 patients from 12 centers who were treated with ENZ in mCRPC. The initial stage, age, line of treatment, serum prostate-specific antigen (PSA) levels before ENZ treatment and at nadir, site of metastasis, gleason score were evaluated. Results: Median age of 320 patients were 69. At a median follow-up of 56 months, 271/320 (84.7%) disease progression and 230/320(71.9%) death had been observed. Median PFS was 11(8.9-13)) and median OS was 25(22.1-27.8) months in all patients group. Median PFS was 10(7.4-12.5) months, 11(8-13.9) months in pre-DTX and post-DTX groups respectively. Median OS was higher in the post-DTX group than the pre-DTX group (28(25.7-30.2) vs 19(15.0-22.9-46.6) (p:0.000). Gleason score ≥ 8 (HR 0.59, 95%CI 0.46-0.77, p=0.00), presence of non-visceral metastasis (HR 0.72, 95%CI 0.53-0.97, p=0.031), initial PSA value<43(median) (HR 0.70, 95%CI 0.54-0.91, p=0.009), PSA at nadir <2 (HR 0.61, 95%CI 0.44-0.85, p=0.004), >50% decline in PSA (HR 0.27, 95%CI 0.19-0.36, p=0.000) significantly predicted ENZ response regarding rPFS. Conclusion: ENZ has shown equal efficacy before and after DTX treatment in mCRPC regarding rPFS. But OS rate was significantly better in the pre-DTX group. Therefore, we recommend starting with DTX in patients who can tolerate chemotherapy in mCRPC setting.
恩杂鲁胺在转移性去势抵抗性前列腺癌(mCRPC)中的作用:一项多中心研究
目的:恩杂鲁胺(Enzalutamide, ENZ)是治疗mCRPC的有效激素治疗方式。在这种情况下,它可以在多西他赛(DTX)之前或之后使用。在此,我们旨在显示使用DTX前后ENZ的疗效以及影响疗效的因素。方法:回顾性收集来自12个中心的320例mCRPC患者的资料。观察患者的初始阶段、年龄、治疗路线、ENZ治疗前及最低点血清前列腺特异性抗原(PSA)水平、转移部位、gleason评分。结果:320例患者中位年龄69岁。在中位随访56个月时,观察到271/320(84.7%)的疾病进展和230/320(71.9%)的死亡。所有患者组中位PFS为11(8.9-13)个月,中位OS为25(22.1-27.8)个月。dtx前组和dtx后组的中位PFS分别为10(7.4-12.5)个月和11(8-13.9)个月。dtx后组的中位OS高于dtx前组(28(25.7-30.2)vs 19(15.0-22.9-46.6) (p:0.000)。Gleason评分≥8分(HR 0.59, 95%CI 0.46 ~ 0.77, p=0.00)、有无内脏转移(HR 0.72, 95%CI 0.53 ~ 0.97, p=0.031)、PSA初始值(PSA下降50%)(HR 0.27, 95%CI 0.19 ~ 0.36, p=0.000)均可预测rPFS的ENZ反应。结论:ENZ对mCRPC的rPFS在DTX治疗前后疗效相当。但dtx前组的OS率明显更好。因此,我们建议在mCRPC中耐受化疗的患者开始使用DTX。
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CiteScore
5.60
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