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Systemic treatment for metastatic castrate resistant prostate cancer: Does seqence matter?

转移性去势抵抗性前列腺癌的全身治疗: seqence是否重要?

  • 影响因子:3.24
  • DOI:10.1002/pros.23954
  • 作者列表:"Andrews JR","Ahmed ME","Karnes RJ","Kwon E","Bryce AH
  • 发表时间:2020-04-01
Abstract

BACKGROUND:Optimal sequencing of systemic therapy in the management for metastatic castration resistant prostate cancer (mCRPC) remains poorly elucidated. The CHAARTED and STAMPEDE studies have proven that early chemotherapy in the hormone-sensitive setting yields a greater net survival advantage than docetaxel for mCRPC. In a retrospective study, we attempt to investigate the two most common treatment sequences for mCRPC and investigate whether earlier chemotherapy for mCRPC is consequential to survival outcomes. METHODS:We identified 112 patients with mCRPC treated at the Mayo Clinic between 2011 and 2017. We identified two cohorts, 80 patients (group A) received full course docetaxel chemotherapy followed by second generation hormone therapy (2nd gen androgen deprivation therapy [ADT]; Abiraterone or Enzalutamide) and 32 patients (group B) treated with 2nd gen ADT followed by docetaxel. The primary endpoint evaluated was 3-year cancer-specific survival. RESULTS:Mean prostate specific antigen at initiation of first treatment was 32.0 in group A and 21.7 in group B (P = .4). Bone metastases were more prevalent in group B (87% vs 58%, P = .01). All other clinicopathologic variables were statistically similar between group A and group B. Three-year cancer-specific survival was 87.4% vs 64.1% for group A and group B, respectively (P = .016). We report a univariate hazard ratio of 3.61 (95% CI, 1.74-9.5, 0 P = .01). Three-year overall survival was 82.4% and 60.8% for group A and group B, P = .01. These results held true when excluding patients with lymph node only metastasi. CONCLUSION:Our data indicates that sequence of systemic therapy may influence outcomes for mCRPC and that docetaxel should be considered before 2nd generation ADT. Our results support the importance of earlier chemotherapy in the castration resistant state.

摘要

背景: 在转移性去势抵抗性前列腺癌 (mCRPC) 的治疗中,系统治疗的最佳测序仍然知之甚少。CHAARTED和STAMPEDE研究已经证明,在激素敏感的情况下,早期化疗比多西他赛对mCRPC产生更大的净生存优势。在一项回顾性研究中,我们试图研究mCRPC最常见的两种治疗序列,并研究mCRPC的早期化疗是否对生存结局有影响。 方法: 我们确定了 2011 年至 112 年间在梅奥诊所接受治疗的 2017 例mCRPC患者。我们确定了两个队列,80 例患者 (A组) 接受全疗程多西他赛化疗,随后接受第二代激素治疗 (第2 代雄激素剥夺治疗 [ADT]; 阿比特龙或Enzalutamide) 32 例患者 (B组) 接受第2 gen ADT治疗,随后接受多西他赛治疗。评价的主要终点是 3 年癌症特异性生存率。 结果: A组首次治疗开始时的平均前列腺特异性抗原为 32.0,B组为 21.7 (p = 4.4)。B组骨转移发生率较高 (87% vs 58%,p =.01)。A组和B组之间所有其他临床病理变量在统计学上相似。A组和B组的三年癌症特异性生存率分别为 87.4% 和 64.1% (p =.016)。我们报告的单变量风险比为 3.61 (95% CI,1.74-9.5,  0 p =  .0 1)。A组和B组的三年总生存率分别为 82.4% 和 60.8%,p = 01.01。当排除仅淋巴结转移的患者时,这些结果是正确的。 结论: 我们的数据表明,全身治疗的顺序可能会影响mCRPC的预后,在第2 代ADT之前应该考虑多西他赛。我们的结果支持在去势抵抗状态下早期化疗的重要性。

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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影响因子:2.83
发表时间:2020-01-01
DOI:10.1007/s00520-019-04843-9
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