非轉移性去勢抗藥性前列腺癌患者使用雄激素受體抑制劑:
單一醫院初步經驗分享
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 

Preliminary single-hospital experience of androgen receptor pathway inhibitors for non-metastatic castration-resistant 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

Apalutamide and Darolutamide were introduced in Taiwan for high-risk non-metastatic Castration-Resistant Prostate Cancer (nmCRPC) in March and November 2021, respectively. This study was aimed to retrospectively compare efficacy of the two androgen receptor pathway inhibitors.

Materials and Methods

Between 2021 and 2023, total 31 patients who had confirmed nmCRPC with a PSA doubling time less than 10 months were included, all of whom had received androgen deprivation therapy. The study comprised three groups: one received apalutamide alone (group 1), another received darolutamide alone (group 2), and the third received either apalutamide, darolutamide or both (group 3). The primary endpoint was metastasis-free survival, defined as the time from the use of the two therapies to the detection of distant metastasis on images or death.

Results

A total of 31 patients were included, consisting of 11 males in group 1, 14 males in group 2 and 31 males in group 3. Six patients had intolerable side effects from apalutamide and switched to darolutamide. After a 2.5-year follow-up, the median metastasis-free survival was not reached among the three groups. The median time to PSA progression, defined as two consecutive rise of absolute PSA level, was 11 months in group 1, 12 months in group 2, and 10 months in group 3. Near 90% PSA response was found in the three group. The percentage of patients stopping the assigned regimen due to adverse events was 35% (6 out of 17) in the apalutamide group and 0% in the darolutamide group.

Conclusion

Among Taiwanese males with nmCRPC, those receiving apalutamide or darolutamide revealed similar metastasis-free survival during a 2.5-year follow-up. Two consecutive rise of absolute PSA levels seemed to occur within one year since the use of ARPi. The incidence of adverse events was higher in the apalutamide group. Finally, a more extended follow-up period would be needed.