更换抗雄药物治疗初始内分泌治疗失效的晚期前列腺癌

Efficacy of Alternative Antiandrogens to Treat Advanced Prostate Cancer That Relapsed after Initial Hormone Therapy

目的观察初始内分泌治疗失效的晚期前列腺癌更换抗雄激素药物的二线内分泌治疗疗效。方法 48例晚期前列腺癌,采用药物或手术去势联合比卡鲁胺(50mg,qd)行全雄激素阻断治疗。初始治疗失效后更换抗雄药物为氟他胺(250mg,tid)进行二线内分泌治疗,以血清PSA值是否下降作为疗效评估指标,观察药物不良反应。结果所有患者均耐受氟他胺治疗。29例(60.4%)血清PSA值下降,其中17例(35.4%)下降>50%,中位有效时间(10.2±3.5)个月;12例(25.0%)下降<50%,中位有效时间(7.4±2.7)个月。19例(39.6%)治疗无效。统计分析显示一线内分泌治疗有效时间长者可获得良好的二线内分泌治疗反应(P<0.05),而Gleason评分,一、二线内分泌治疗前PSA及治疗后PSA谷值均与二线内分泌治疗疗效无关。结论晚期前列腺癌初始内分泌治疗失效后,部分患者更换抗雄激素药物仍可取得一定疗效,可作为细胞毒化疗前的有效选择。

Objective To evaluate the efficacy of second-line hormone therapy with flutamide in patients who relapsed after initial maximum androgen blockade (MAB). Methods 48 patients were treated with MAB u-sing flutamide (375 mg daily)as second-line hormonal therapy. All patients were initially treated with first-line MAB consisting of either medical or surgical castration plus bicalutamide,which failed. The effect of second-line MAB was evaluated by the serum PSA level,and the response was divided into >50% and <50% PSA reductions from baseline PSA at the start of second-line hormonal therapy. Results PSA reduction was observed in 29 patients (60. 4%). Among them,17 (35. 4%)achieved >50% PSA reductions with a mean response duration of (10. 2 ± 3. 5)months. 12 (25. 0%)patients achieved <50% PSA reductions with a mean response duration of (7. 4 ± 2. 7)months. Patients with long-time response duration of first-line MAB had a signifi-cantly higher incidence of PSA response to second-line therapy,other factors such as age,Gleason score,ser-um PSA before the start of first-line or second-line hormonal therapy,nadir PSA level after first-line or sec-ond-line hormonal therapy were not correlated to the response of second-line therapy. Conclusions Second-line MAB using flutamide is suitable for patients who relapse after initial MAB therapy using bicalutamide,par-ticularly in those with long-time response duration of first-line MAB,and may be an effective treatment option before cytotoxic chemotherapy.