同時使用化療賀爾蒙治療於轉移性荷爾蒙敏感型攝護腺癌之病人
方仁愷、吳錫金、謝博帆、張兆祥、楊啟瑞、葉進仲、陳冠亨、林精湛1、林哲弘1、葉士芃1
中國醫藥大學附設醫院 泌尿部，1腫瘤部
Real world experience of upfront chemohormonal therapy in metastatic hormone-sensitive prostate cancer
Jen-Kai Fang, Hsi-Chin Wu, Po-Fan Hsieh, Chao-Hsiang Chang, Chi-Rei Yang, Chin-Chung Yeh, Guang-Heng Chen, Ching-Chan Lin1, Che-Hung Lin1, Shih-Peng Yeh1
Department of Urology and 1Oncology, China Medical University Hospital, Taichung, Taiwan
Purpose
Recent two clinical trials (CHAARTED and STAMPEDE) showed survival benefit of upfront docetaxel in metastatic hormone-sensitive prostate cancer (mHSPC). The aim of this study is to evaluate the real world experience in China Medical University Hospital.
Materials and Methods
Between June 2014 and October 2018, we retrospectively reviewed patients with mHSPC. 28 patients received docetaxel in addition to androgen deprivation therapy for newly diagnosed mHSPC because of high volume disease or consensus of team meeting. The high volume disease was defined as patients with visceral metastasis or more than 3 bone metastasis with at least one outside the spine or pelvis. Patients followed the regimens of 50mg/m2 docetaxel biweekly for 9 cycles or 75mg/m2 docetaxel triweekly for 6 cycles. We analyzed the PSA response and side effects of chemotherapy.
Results
In this case series, the median age was 66 years (IQR 60-73). The median iPSA was 276.7(IQR 118-1510). 21 patients (75%) had high volume mHSPC and 6 patients had visceral metastasis. Most of the patients received 50 mg/m2 docetaxel biweekly in the early era and we offered more regimen of 75 mg/m2 triweekly after clinical trial reported. (50 mg/m2 biweekly: 20 patients; 75 mg/m2 triweekly: 6 patients). After the median follow-up time of 24.8 months, 6 patients (21.4%) had the PSA levels less than 0.2 ng/ml in 6 months and 1 patient (3.6%) did in 12 months. (All of them were 50 mg/m2 regimen). The 2- year overall survival rate was 65.6%. The 2-year biochemical progression free survival rate was 32.5%. Mention of adverse effects of chemotherapy, 6 patients (21.4%) had neutropenia and 4 of whom used prophylactic GCSF (2 were 50 mg/m2 regimen and 2 were 75 mg/m2 regimen). 5 patients (17.9%) had peripheral neuropathy, 4 patients (14.3%) had malaise and 2 patients (7.1%) had limbs edema. 6 patients couldn’t complete the chemotherapy course due to intolerable side effects or poor general performance.
Conclusions
In our real world experience, patients with regimen of 50 mg/m2 biweekly had good PSA response and had lower rate of severe neutropenia than 75 mg/m2 triweekly regimen. Most of the adverse effects were manageable. The survival benefit for these patients will be further analyzed in the future.