鐳-223於轉移性去勢抗性攝護腺癌病人之治療結果—台北榮總經驗
余秉軒1、魏子鈞1,2,3、張延驊1,2,3、黃逸修1,2,3、林子平1,2,3、鍾孝仁1,2,3、黃志賢1,2,3
台北榮民總醫院泌尿部1；國立陽明大學醫學系泌尿學科2；書田泌尿科學研究中心3
The treatment result of Radium-223 on metastatic castration-resistant prostate cancer patients – experience in Taipei Veterans General Hospital
Ping-Hsuan Yu1, Tzu-Chun Wei1,2,3, Yen-Hwa Chang1,2,3, Eric Yi-Hsiu Huang1,2,3,
Tzu-Ping Lin1,2,3, Hsiao-Jen Chung1,2,3, William J.S. Huang1,2,3
1 Department of Urology, Taipei Veterans General Hospital
2 Department of Urology, School of Medicine, National Yang-Ming University
3Shu-Tien Urological Science Research Center, Taipei, Taiwan
Purpose:
Among systemic life-prolonging agents for metastatic castration-resistant prostate cancer (mCRPC), Radium-223 (Ra-223) is a radioactive isotope which emits α–particle and targets symptomatic bony metastases. According to ALSYMCA trial, Ra-223 inhibits the deterioration of metastatic bony structure and further prevents patients from skeleton-related events (SRE). In this study, we retrospectively reviewed the treatment response and adverse events of Ra-223 in a single institute.
Materials and Methods:
Data of patients with Ra-223 treatment were reviewed from April 2014 to January 2019. Patients with treatment doses less than four were excluded. The initial prostate-specific antigen (PSA), Gleason grouping, staging, and previous systemic treatment, were evaluated. Progressive disease (PD) was defined as at least two of the three criteria, including clinical, biochemical and radiological progression, while the stable disease (SD) plus partial remission (PR) were defined as clinical benefit rate (CBR). Lab data before and after the treatment were evaluated to find possible predictive biomarkers, as well as adverse effects. Spider plot concerning percentage change of alkaline-phosphatase (ALK-P), lactate dehydrogenase (LDH), and PSA were also illustrated and calculated statistically.
Results:
Total 19 patients were included. Five patients (26.3%) were defined as PD, with the CBR of 73.7%. The demographic data including age at diagnosis and treatment, BMI, initial Gleason group and stage, lymphadenopathy degree, previous systemic treatment and concurrent treatment such as abiraterone or enzalutamide or docetaxel, were not significantly different between CBR and PR, except the initial PSA level (CBR 220.20 versus PD 971.86 ng/ml, p=0.034). The hematological and biochemical data at the baseline, including ALK-P and LDH, were also statistically insignificant. The safety profile was acceptable. Between CBR and PD, the mean percentage of subsequent ALK-P, LDH, and PSA compared to baseline were significantly different. The spider plot of ALK-P demonstrated a generalized decreasing pattern among PD, SD, or PR groups. However, the trend of LDH and PSA in each spider plot was separated significantly.
Conclusions:
In this study, the CBR was 73.7%. The initial PSA level at diagnosis was higher in the PD group. Generalized ALK-P decrease was noted in both PD and CBR group. As to LDH or PSA level, a diverse trend was illustrated. During Ra-223 treatment, the mean percentage of subsequent ALK-P, LDH, and PSA compared to baseline were statistically significantly different between PD and CBR group.