醋酸阿比特龙联合强的松治疗去势抵抗型前列腺癌的疗效分析

doi:10.3969/j.issn.1006-7795.2021.06.013

摘要/Abstract

摘要： 目的分析去势抵抗型前列腺癌(castration resistant prostate cancer,CRPC)患者接受醋酸阿比特龙(abiraterone acetate,AA)联合强的松(prednisone,P)治疗的疗效及安全性,为后续治疗提供经验。方法筛选2018年7月至2021年4月首都医科大学附属北京朝阳医院泌尿外科共计46例CRPC患者,选择使用AA+P治疗,最后共计37例患者纳入研究。分析37例患者的基本资料,参照前列腺特异抗原(prostate specific antigen,PSA)工作组2(PSA Working Group 2, PSAWG2)标准计算PSA缓解率,按照实体瘤的疗效评价(response evaluation criteria in solid tumors,RECIST)标准评估患者治疗期间的影像学结果,同时分析行多西他赛化疗、PSA闪烁现象以及基线PSA水平、肿瘤T分期、Gleason评分等指标对AA+P治疗的PSA缓解率的影响差异。结果 37例CRPC患者接受AA+P治疗,中位随访时间9.7个月。在接受AA+P初始,有5例患者发生了PSA闪烁现象,其PSA达峰再次下降至基线水平以下的中位时间为3.0(2.0,4.5)个月。37例患者PSA总体缓解率为59.5%,其中13例患者达到缓解后又发生了PSA复发,其中位复发时间为7.0个月。参照RECIST标准,37例CRPC患者中,有7例患者发生了影像学进展,而5例有明确的影像学缓解。6例达到PSA缓解后出现复发的患者将强的松转换为地塞米松,其中2例PSA再次缓解,PSA缓解率为33.3%。化疗失败后接受AA+P的患者PSA缓解低于未行化疗的患者(20.0% vs 65.6%,P=0.076)。此外,有PSA闪烁现象的PSA缓解率低于无此现象的患者(20.0% vs 65.6%,P=0.076)。醋酸阿比特龙的总体耐受性较好,药物不良反应少。结论 CRPC患者口服醋酸阿比特龙联合强的松疗效确切,安全性高,对于不愿意选择或不能耐受化疗的患者,有较高的PSA缓解率。PSA闪烁现象在AA治疗过程中并不少见,这部分患者达到PSA缓解的比例较低。PSA缓解后的中位复发时间为7.0个月,部分PSA进展患者用地塞米松替换强的松可重新达到PSA缓解,可恢复对阿比特龙治疗的敏感性。

关键词: 去势抵抗型前列腺癌, 醋酸阿比特龙, PSA复发, PSA闪烁, 多西他赛

Abstract: Objective To analyze the efficacy and safety of abiraterone acetate (AA) combined with prednisone (P) in patients with castration-resistant prostate cancer (CRPC). Methods Retrospective analysis was performed on 46 CRPC patients who were treated with AA+P from July 2018 to April 2021 in the Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, and finally 37 patients were included in the study. To analyze the basic data of 37 patients, the prostate specific antigen (PSA) response rate was calculated according to the PSA Working Group 2 (PSAWG2) standard, and the patient’s imaging outcome during treatment was evaluated according to response evaluation criteria in solid tumors(RECIST) standard. The difference in PSA response rate was compared with each other group for AA+P treatment with/without docetaxel chemotherapy. Results The median follow-up time was 9.7 months after 37 CRPC patients received AA+P treatment. At the beginning of receiving AA+P, 5 patients had PSA flare, and the median time for their PSA rising to peak followed by a drop below the baseline level was 3.0(2.0,4.5) months. The overall PSA response rate of 37 patients was 59.5%, of which 13 patients had PSA recurrence after reaching remission, with a median recurrence time of 7.0 months. According to RECIST criteria, of 37 CRPC patients, 7 patients had imaging progression, and 5 patients had definite imaging remission. Six patients who relapsed after reaching PSA remission were treated with dexamethasone as an alternative of prednisone. Among them, 2 patients had PSA response, with the PSA response rate 33.3%. For the patients with or without docetaxel chemotherapy, the PSA response rate was 20.0% (1/5), and 65.6% (21/32),respectively. There was no statistically significant difference in response rate (P=0.076). In addition, the response rate of PSA of patients with PSA flare was significantly lower than that without this phenomenon (20.0% vs 65.6%, P=0.070). Abiraterone acetate was generally well tolerated and had fewer adverse drug reactions. Conclusion In CRPC patients, oral abiraterone acetate combined with prednisone had a definite effect and high safety. For patients who were unwilling to choose or could not tolerate chemotherapy, there is a higher PSA response rate. PSA flare was not uncommon during AA treatment, and the proportion of these patients who achieved PSA response was relatively low. The median time to recurrence after PSA response was 7.0 months, and some patients with PSA progression could regain PSA response by replacing prednisone with dexamethasone.

Key words: castration-resistant prostate cancer, abiraterone acetate, PSA progression, PSA flare, docetaxel

中图分类号:

R737.25

叶小波, 熊天宇, 崔韵, 王明帅, 杨辉, 安卓玲, 牛亦农. 醋酸阿比特龙联合强的松治疗去势抵抗型前列腺癌的疗效分析[J]. 首都医科大学学报, 2021, 42(6): 978-985.

Ye Xiaobo, Xiong Tianyu, Cui Yun, Wang Mingshuai, Yang Hui, An Zhuoling, Niu Yinong. Efficacy of abiraterone acetate combined with prednisone in the treatment of castration-resistant prostate cancer[J]. Journal of Capital Medical University, 2021, 42(6): 978-985.

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