轉移性去勢抗性攝護腺癌化療後使用Abiraterone
之治療經驗
蘇楷森1,、黃逸修1,2,、顧明軒1,2,、陳威任1,2,、黃子豪1,2,、魏子鈞1,2,、黃奕燊1,2,、
范玉華1,2,、林志杰1,2,、林子平1,2,、鍾孝仁1,2,、郭俊逸1,2,、張延驊1,2,、林登龍1,2,、黃志賢1,2,
1臺北榮總泌尿部；2國立陽明交通大學醫學系泌尿學科
A Single Center Experience of Abiraterone in Patients with
Metastatic Castration-resistant Prostate Cancer Previously Treated with
Docetaxel Based Chemotherapy
Kai-Sen Su1, Eric Yi-Hsiu Huang1,2,, Ming-Hsuan Ku1,2,, Wei-Ren Chen1,2,, Tzu-Hao Huang1,2,, Tzu-Chun Wei1,2,, I-shen Huang1,2,, Yu-Hua Fan1,2,, Chih-Chieh Lin1,2,, Tzu-Ping Lin1,2,,
Hsiao-Jen Chung1,2,, Junne-Yih Kuo1,2,, Yen-Hwa Chang1,2,, Alex T.L. Lin1,2,,
William J.S. Huang1,2,
1 Department of Urology, Taipei Veterans General Hospital;
2 Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
Purpose: Abiraterone, an androgen receptor-targeted agent (ARTA), has shown survival benefit in patients with metastatic castration-resistant prostate cancer (mCRPC) after docetaxel-based chemotherapy in randomized controlled trials (RCT). It has been reimbursed by National Health Insurance (NHI) as first-line therapy for patients with mCRPC after chemotherapy since 2014. Herein, we would like to present our experiences.
Materials and Methods: Patients with mCRPC who were treated with Abiraterone as first-line therapy after chemotherapy in Taipei Veterans General Hospital were reviewed from January 2015 to May 2021. The patients were regularly followed with blood tests and imaging studies including CT and whole body bone scan every 3 months. Clinical parameters included demographics, initial prostate specific antigen (iPSA), Gleason grade group, disease volume, chemotherapy dosage, and Abiraterone treatment details were collected. The main outcomes were biochemical progression-free survival (BPFS) and radiographic progression-free survival (rPFS). Overall survival (OS), and PSA response were also evaluated. Cox regression survival analysis was used to assess BPFS and rPFS. Univariate and multivariate analysis were conducted.
Results: In total, 75 patients with mCRPC who used Abiraterone as first-line therapy after chemotherapy were included. The median age was 73.8 years (IQR 60.4-89.3). The median follow-up was 10.6 months (IQR 3.75-21.75). The median duration of Abiraterone use was 10.6 months (IQR 2.83-12.65). The median BPFS and rPFS were 4.2 months (95% CI, 5.3-10.7) and 6.4 months (95% CI, 8.7-16.0), respectively. PSA response rate was 49.3% with the definition of reduction in the PSA level by 50% or more. PSA response served as strong indicator for longer BPFS and rPFS, with hazard ratio of 2.09 (95% CI, 1.29-3.39, p < 0.01) and 3.28 (95% CI, 1.90-5.65, p < 0.01), respectively. Pre-Abiraterone visceral metastasis served as risk factor for biochemical failure, with hazard ratio of 2.49 (95% CI, 1.39-4.46, p < 0.01) . Pre-Abiraterone Hemoglobin level ≤ 11.7 was shown as risk factor for radiographic progression, with hazard ratio of 2.00 (95% CI, 1.06-3.79, p = 0.03). Other variables including iPSA, Gleason grade group, chemotherapy dosage and disease volume before Abiraterone didn’t meet statistical significance as risk factors of BPFS and rPFS. The median OS was 10.7 months (95% CI, 12.9-20.0).
Conclusion: Our experiences provided the real-world outcome of Abiraterone in post-chemotherapy setting of Taiwanese population which was comparable to previous RCT. PSA response was shown to be an independent risk factor for BPFS and rPFS. Pre-Abiraterone visceral metastasis was associated with a higher risk of biochemical failure, and anemia was associated with a higher risk of radiographic progression.