比較化療與新興賀爾蒙藥物在化療前或化療後治療轉移性賀爾蒙抗性攝護腺癌的臨床結果

吳芃諺、李建儀、裘坤元、王賢翔、楊晨洸、陳卷書、盧嘉文、陳正哲、王樹吉、林嘉彥、洪晟鈞

台中榮民總醫院 外科部 泌尿科

Comparison of the Clinical Outcomes of Chemotherapy and Novel Hormone Agents in Pre-chemotherapy and Post-chemotherapy Settings for Treatment of Metastatic Castration-Resistant Prostate Cancer

Peng-Yen Wu, Jain-Ri Li, Kun-Yuan Chiu, Shian-Shiang Wang, Cheng-Kuang Yang, Chuan-Shu Chen, Kevin Lu, Cheng-Che Chen, Shu-Chi Wang, Chia-Yen Lin, Sheng-Chun Hung

Division of Urology, Department of Surgery, Taichung Veterans General Hospital

Purpose: Metastatic castration-resistant prostate cancer (mCRPC) is a status of disease with resistance to androgen deprevation therapy (ADT). Docetaxel and novel hormone agents (NHAs), including abiraterone acetate and enzalutamide, have been developed for mCRPC treatment to improve survival. To compare and understand the changing landscape of mCRPC treatment, we retrospective collected patients in our hospital and performed a comprehensively statistical analysis.

Materials and Methods: This was a retrospective chart-review study that enrolled mCRPC patients who have ever received at least one of the following medications: docetaxel, abiraterone acetate or enzalutamide. The patients were seperated into 3 groups: chemotherapy-only, chemotherapy-naive NHA (either abiraterone acetate or enzalutamide), and post-chemotherapy NHA groups. The clinical outcomes were compared, including overall survival and PSA response.

Results: From December, 2004 to December, 2020, 501 patients were enrolled in this study. The chemo-only group has the older patient population (84 years, p<0.001), and higher levels of PSA then the other 2 groups (15.45 ng/mL at mCRPC and 77.60 ng/mL at first treatment, p=0.001 and p<0.001, respectively). The median pre-mCRPC ADT duration was 18.99 months, and the duration of chemo-naive-NHA group was significant longer then the other 2 groups (25.99 months, p=0.002). Uni-multi variant analysis of overall survival (OS) from mCRPC revealed that pre-mCRPC ADT duration and enzalutamide use were associated with decreased risk of death (HR=0.99, 95% CI 0.99-1.00, p=0.002, and HR=0.57, 95% CI 0.38-0.86, p=0.008, respectively). Both high volume metastatic prostate cancer (mPC) (HR=1.69, 95% CI 1.34-2.14, p<0.001) and high risk mPC (HR=1.70, 95% CI 1.34-2.16, p<0.001) were associated with increased risk of death. The uni-multi variant analysis showed that upfront docetaxel and pre-mCRPC ADT duration were associated to increased PSA response (OR=4.15, 95% CI 1.86-9.40, p=0.001, and OR=1.01, 95% CI 1.00-1.01, p<0.048 respectively). The Kaplan-Meier curve estimated that the chemo-naive-NHA group has significantly longer survival then chemo-only group and post-chemo-NHA group (47.1 vs. 39.8 vs. 19.8 months, p<0.001).

Conclusions: The chemotherapy-naive NHA improves the survival after mCRPC. After analysis with multivariate model, enzalutamide use, longer ADT duration before mCRPC are related to decreased mortality. High volume and high risk mPC were related to increased risk of death. Upfront Docetaxel and longer ADT duration were related to better PSA response.