转移性去势抵抗性前列腺癌多西他赛/泼尼松治疗失败后加用雌二醇氮芥的疗效和安全性:单中心回顾性研究

Addition of estramustine to prednisone/docetaxel for patients with metastatic castration-resistant prostate cancer after P/D failure: a single-center experience

目的:研究雌二醇氮芥/多西他赛/泼尼松(Estramustine/Prednisone/Docetaxel,E/D/P)联合治疗多西他赛/泼尼松(Prednisone/Docetaxel,D/P)失败后转移性去势抵抗性前列腺癌(mCRPC)患者的的疗效和安全性。方法:2005年11月~2015年7月我院40例D/P治疗失败的mCRPC患者接受了E/D/P联合治疗方案。将血清PSA水平降低50%作为主要终点。并对其化疗毒性进行评价。结果:所有患者接受了185个周期的E/D/P治疗。40例均符合安全性评价,35例符合疗效评价。总中位无生化进展生存期为17.1周,中位总生存期为85.7周,62.8%(22/35)的患者有治疗应答,E/D/P应答者的总生存期明显优于E/D/P无应答者(104.6周vs.65.1周)。尽管在15%的患者中有3~4级的嗜中性粒细胞减少症,但这种联合治疗方案总体上是可以耐受的。结论:回顾性资料表明,雌二醇氮芥能有效逆转多西他赛的耐药性,延长生存期。E/D/P联合治疗D/P失败后的mCRPC患者的治疗效果明显,且毒性可接受。

Objective:To investigate the efficacy and safety of Estramustine/Prednisone/Docetaxel combination(E/P/D)as salvage chemotherapyforpatients with metastatic castration-resistant prostate cancer(mCRPC)after the failure of Prednisone/Docetaxel(P/D).Method:Forty mCRPC patients for whom P/D treatment had failed received E/P/D treatment between November 2005 to July 2015.A decrease of>50%in serum PSA level was set as the primary endpoint.The toxicity profiles were also reviewed.Rusult:Patients received a total of 185 cycles of E/P/D treatment.All 40 cases were eligible for safety analysis,and 35 cases were eligible for the evaluation of treatment effect.The media nbiochemical progression-free survival was 17.1 weeks,and the media noverall survival was 85.7 weeks.Furthermore,62.8%(22/35)patients had treatment response,and the overall survival in responders to E/P/D therapy was significantly better than that innonresponders.Despite grade 3-4 neutropenia in 15%of patients,this combination was in general tolerable.Conclusion:Retrospective dataindicated estramustine effectively reverse resistance of docetaxel and prolonging survival.E/P/D combination is relatively active with acceptable toxicity profile as salvage treatment for mCRPC patientsafter the failure of P/D.