化療前接受阿比特龍加上培尼皮質醇及安可坦之轉移性去勢療法無效攝護腺癌之病人特徵
林晏頎、林柏宏、馮思中、黃亮鋼、曲元正、甘弘成、邵翊紘、虞凱傑、莊正鏗
林口長庚醫院外科部泌尿外科, 長庚大學
Characteristics of mCRPC Patients Received Abiraterone Acetate plus Prednisolone and Enzalutamide before Chemotherapy
Yen-Chi Lin , Po-Hung Lin , See-Tong Pang, Liang-Kang Huang, Yuan-Cheng Chu, Hung-Cheng Kan , I-Hung Shao, Kai-Jie Yu, Cheng-Keng Chuang
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
Purpose: Androgen deprivation therapy (ADT) has been the main treatment for patients with metastatic prostate cancer (mPCa). However, most of the prostate cancers would develop drug resistance and inevitably progress to castration-resistant prostate cancer (CRPC). Novel hormonal agents (NHAs), such as Abiraterone Acetate (AA) and Enzalutamide (ENZ were proved as life-prolonging agents for patients with mCRPC. In Taiwan, due to the reimbursement regulation of National Health Insurance, AA with prednisone (AA+P) and ENZ can only be prescribed mutual exclusive for patients with mPCa. The current study aimed to explore the characteristics of patients received AA+P and ENZ in the pre-chemotherapy setting in Taiwan.
Materials and Methods: We retrospectively evaluated the patients with mCRPC between 2016 and 2019 who had received AA+P or ENZ after primary ADT (either surgical or medical castration, with or without anti-androgen) before chemotherapy at Chang Gung Memorial Hospital (CGMH), Linkou Branch. The demographic data and PSA kinetics kinetics were analyzed.
Results: From January 2016 to December 2019, a total 97 patients with newly diagnosed prostate cancer who had received AA+P or ENZ after primary ADT failed were recruited for analysis. Among them, 70 patients (72.16%) received AA+P, while 27 (27.84%) received ENZ. Before the treatment of NHA, the mean PSA nadir of first line ADT in AA+P and ENZ group were 0.41 and 0.9 respectively. The median duration of response to 1st line ADT was longer in AA+P than ENZ group (1232 vs. 666 days). There was no significant difference regarding the initial PSA before NHA treatments and post-NHA PSA nadir in these two groups. The median duration of response was longer in ENZ than AA+P group (535 vs. 385 days).
Conclusion: Since the Abiraterone Acetate plus Prednisolone and Enzalutamide could only be prescribed mutual exclusive for mCRPC patients in Taiwan, to understand the characteristics and PSA kinetics and analyze the duration of response of each drug could help clinicians to select patients who would be more responsive to the respective agents.