前列腺癌的二线化疗:患者特征和生存

Kathleen W. Beekman , Mark T. Fleming , Howard I. Scher , Susan F. Slovin , Nicole M. Ishill , Glenn Heller , W. Kevin Kelly
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引用次数: 33

摘要

目的:与以米托蒽醌为基础的治疗相比,多西紫杉醇在进展性去势转移性前列腺癌患者中的一线化疗可提高总生存率。一线抗菌素小管治疗后化疗的使用和结果尚未得到很好的描述。患者和方法采用基于抗微管治疗方案的进行性去势转移性前列腺癌患者进行随访,以确定其基线特征和二线或三线全身治疗的结果。结果108例患者中,81%的患者接受了二线治疗,40%的患者接受了三线治疗。相应的前列腺特异性抗原(PSA)降低≥50%的患者分别为72%、15%和22%。从一线、二线和三线治疗开始的中位生存时间分别为21个月(95%置信区间[CI], 18-25个月)、13个月(95% CI, 10-15个月)和12个月(95% CI, 9-19个月)。二线患者生存的重要预后指标包括预处理PSA水平、碱性磷酸酶水平和工作状态。不适合接受二线治疗的患者在接受一线治疗时症状更明显,一线治疗后更需要麻醉治疗(67%对15%)和姑息性放射治疗(57%对10%),而不是二线全身治疗。结论80%的患者接受了二线化疗,从二线治疗开始的中位生存期为12个月。虽然只有40%的患者接受了三线化疗,但中位生存期与二线患者相似。我们的数据显示,有症状开始化疗的患者更有可能需要姑息性放疗,而不是化疗作为二线治疗。序贯或持续的治疗可以优化这类有症状患者的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Second-Line Chemotherapy for Prostate Cancer: Patient Characteristics and Survival

Purpose

First-line chemotherapy with docetaxel in patients with progressive castrate metastatic prostate cancer has been shown to improve overall survival compared with mitoxantrone-based therapies. The use and outcomes of chemotherapy after first-line antimicrotubule-based therapy have not been well described.

Patients and Methods

Patients with progressive castrate metastatic prostate cancer enrolled on an antimicrotubule-based protocol for treatment were followed to determine their baseline characteristics and outcomes with second- or third-line systemic therapy.

Results

Of 108 patients treated with antimicrotubulebased therapy, 81% received second-line therapy, and 40% received third-line therapies. Corresponding prostate-specific antigen (PSA) decreases ≥ 50% were observed in 72%, 15%, and 22% of patients. Median survival times from the start of first-, second-, and third-line therapy were 21 months (95% confidence interval [CI], 18-25 months), 13 months (95% CI, 10-15 months) and 12 months (95% CI, 9-19 months). Significant prognostic indicators for survival in the second-line setting include pretreatment PSA level, alkaline phosphatase level, and performance status. Patients not fit to receive second-line therapy were more symptomatic with first-line therapy, as illustrated by a greater need for narcotic therapy (67% vs. 15%) and palliative radiation therapy after first-line therapy (57% vs. 10%) in lieu of second-line systemic therapy.

Conclusion

Eighty percent of patients received second-line chemotherapy, with a median survival of 12 months from the start of second-line treatment. Although only 40% received third-line chemotherapy, median survival was similar to that of patients in the second-line setting. Our data show that patients who initiate chemotherapy with symptoms are more likely to require palliative radiation therapy rather than chemotherapy as second-line therapy. A sequential or continuous administration of therapy may optimize the care of this subset of symptomatic patients.

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