轉移性荷爾蒙敏感型前列腺癌患者使用雄激素受體抑制劑:

單一醫院期中經驗分享
柯旭承¹、林益聖¹、翁瑋駿¹、黃立華¹、蔡沛綺¹、陳怡妤¹、許兆畬¹、

歐宴泉¹、童敏哲¹ 

童綜合醫療社團法人童綜合醫院 外科部 泌尿科 

Interim single-hospital experience of androgen receptor pathway inhibitors for metastatic hormone-sensitive prostate cancer

Ko Hsu-Cheng¹、Lin Yi-Sheng¹、Weng Wei-Chun¹、Huang Li-Hua¹、Tsai Pei-Chi¹、 Chen Yi-Yu¹、Hsu Chao-Yu¹、Ou Yen-Chuan¹、Tung Min-Che¹

¹Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung City, Taiwan

Purpose

Abiraterone acetate, enzalutamide and apalutamide were introduced in Taiwan for the therapy of high-risk metastatic hormone-sensitive prostate cancer (mHSPC) in 2020. This study was aimed to retrospectively compare efficacy of the three androgen receptor pathway inhibitors.

Materials and Methods

Between 2020 and 2023, total 54 patients who had confirmed high-risk mHSPC were included, all of whom had received androgen deprivation therapy. The study comprised four groups: one received abiraterone alone (group 1), another received enzalutamide alone (group 2), another received apalutamide (group 3) and the other included all patients (group 4). The primary endpoint was radiographic progression-free survival (rPFS), defined as the time from the use of the above therapy to the detection of distant metastasis on images or death.

Results

As of November 30, 2023, a total of 54 patients were included, consisting of 27 males in group 1, 8 males in group 2 and 19 males in group 3. After a 3.5-year follow-up, the median length of rPFS was 25 months in abiraterone group, 11.5 months in enzalutamide group and 20.75 months in apalutamide group.  Abiraterone group showed better outcomes on overall survival, time to PSA progression, time to initiation of new antineoplastic therapy or Ra-223, and time to first symptomatic skeletal event. Apalutamide group showed shorter time to reach PSA nadir and higher PSA undetectable rate. As of adverse events, skin itching or rash was similar in both enzalutamide and apalutamide group.

Conclusion

Among Taiwanese males with mHSPC, those using abiraterone take more time to reach PSA nadir but had longer length of rPFS and overall survival. Time to PSA progression, defined as two consecutive rise of absolute PSA levels, was also longest in the abiraterone group. The incidence of adverse events was highest in the apalutamide group. Finally, a more extended follow-up period would be needed.