使用Abiraterone acetate治療轉移性去勢敏感性攝護腺癌之經驗

江長和¹、黃逸修 ^1,2、張延驊^1,2、鍾孝仁^1,2、林子平^1,2、林志杰^1,2、黃奕燊^1,2、魏子鈞^1,2、黃子豪^1,2、陳威任^1,2、黃志賢^1,2

¹臺北榮民總醫院泌尿部

²國立陽明交通大學醫學院泌尿學科 書田泌尿科學研究中心

A real-world experience of using Abiraterone acetate in the treatment of metastatic castration sensitive prostate cancer

Chang-Ho Chiang¹, Eric Yi-Hsiu Huang^1,2, Yen-Hwa Chang^1,2,

Hsiao-Jen Chung^1,2,Tzu-Ping Lin^1,2,Chih-Chieh Lin ^1,2,I-Shen Huang^1,2,

Tzu-Chun Wei^1,2, Tzu-Hao Huang^1,2,Wei-Jen Chen^1,2,William J. Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital,

²Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

The combination of abiraterone acetate and prednisone with androgen deprivation therapy (ADT) had been proven effective to improve the overall survival of high risk metastatic castration sensitive prostate cancer (mCSPC). In addition, Abiraterone acetate has been reimbursed by the National Health Insurance (NHI) for high risk mCSPC of modified definition from May 1^st, 2020,. This study aimed to present the experience of using abiraterone acetate plus prednisone for the treatment of mCSPC in our real world clinical practice.

Materials and Methods:

We enrolled the patients with high risk mCSPC who received abiraterone acetate plus prednisone with ADT from January 2020 to March 2021 in our hospital (VGHTPE). Adverse events (bone event, cardiac event, brain event) and serum biochemistry parameters were monitored during the whole course of abiraterone acetate at each clinic visit. The clinical response and adverse events (AEs) were reported.

Results

In total, 39 patients were enrolled since January 1st, 2020 which accounted for about 70% of the patients with prostate cancer diagnosed in the same period. Among them, 33 patients (84.6%) were Gleason score ≥8, 34 patients (87.2%) had four or more metastatic bone lesions and at least one at appendicular bone on bone scan, and 12 patients (30.8%) had visceral metastasis (most in lung). There were 5 patients (12.8%) meeting all three high-risk criteria. Interestingly, 3 patients didn’t meet the high-risk criteria of NHI but got reimbursed. After a median follow-up of 7.7 months (IQR 5.2−9.7), 3 patients discontinued abiraterone acetate due to disease progression related death, PSA progression, and poor compliance of medication, respectively. Thirty-six patients (92.3%) were still on the treatment until March, 2021 with a median treatment duration of 7.85 moths. The PSA response rate at 3 month, defined as decline of PSA ≥ 50%, was 87.2%. The common AEs were hypertension (N=2 ,5.1%), diabetes (N=3, 7.6%), and hypokalemia (N=3, 7.6%). Liver function elevation was noted in 6 patients (15.4%). All of above AEs were grade 1 in Common Terminology Criteria for Adverse Events. However, there were grade 3 adverse events in two (5.1%) patients who experienced pathological fracture of femoral neck and acute small infarct in left thalamus.

Conclusions

Our preliminary experiences showed high PSA response rate of abiraterone acetate in the treatment of high-risk mCSPC. However, certain patients suffered from treatment related AEs but no patients discontinued the medication due to AEs. Prolonged follow up is needed for further survival outcomes.