Clinical analysis of sequential treatment using abiraterone and enzalutamide for metastatic castration-resistant prostate cancer
Objective:To analyze the real-world data on the sequential treatment regimen of abiraterone acetate followed by enzalutamide in Chinese patients with metastatic castration-resistant prostate cancer(mCRPC).Meth-ods:The retrospective analysis included 136 mCRPC patients treated with abiraterone acetate followed by enzalu-tamide from January 2018 to April 2023.The patients were divided into two groups based on the treatment strate-gy in the metastatic hormone-sensitive prostate cancer(mHSPC)stage:the"combination therapy"group and the"step-wise therapy"group.In the combined therapy group,57 patients received androgen deprivation therapy(ADT)combined with abiraterone and prednisone during the mHSPC stage.In the step-wise therapy group,79 patients were initially treated with ADT during the mHSPC stage,and subsequently progressed to mCRPC before receiving combined treatment with abiraterone plus prednisone.The primary endpoint was the proportion of pa-tients with a PSA maximum decline of over 50％(PSA50)following enzalutamide treatment.Results:The mean duration of enzalutamide use was(4.5±2.2)months,and 18.38％of patients achieved a PSA50 response.Multi-factorial analysis revealed that the treatment strategy at the mHSPC stage(combined treatment vs.step-wise treatment)(OR=4.52,95％CI:1.27-16.14,P=0.02),the effective duration of abiraterone(OR=1.11,95％CI:1.03-1.19,P=0.005),and the time interval from frontline abiraterone treatment progression to se-quential enzalutamide(OR=0.83,95％CI:0.72-0.95,P=0.007)were independent predictive factors for PSA50.By using propensity score matching based on clinical baseline characteristics,patients in the combination therapy group and the step-wise therapy group were matched at a 1∶1 ratio.The results demonstrated that pa-tients in the combination therapy group had a higher PSA50 response compared to those in the step-wise therapy group(31.58％vs 7.02％).Conclusion:Sequential treatment using abiraterone acetate and enzalutamide can lead to PSA response in some mCRPC patients.Those with longer frontline abiraterone effective duration,a shorter time interval from frontline abiraterone treatment progression to sequential enzalutamide,and the use of ADT combined with abiraterone therapy strategy during the mHSPC period are more likely to experience PSA50 during sequential therapy.
万方数据
维普
