恩扎卢胺治疗阿比特龙耐药的转移性去势抵抗性前列腺癌19例疗效观察

Outcomes of alternative Enzalutamide after abiraterone failure in metastatic castration-resistant prostate cancer:a report of 19 real-world cases

目的观察恩扎卢胺在醋酸阿比特龙耐药后的转移性去势抵抗性前列腺癌患者中应用的有效性和安全性。方法收集我院2017年10月至2018年10月采用醋酸阿比特龙治疗耐药的19例转移性去势抵抗性前列腺癌患者的临床资料。19例患者在出现生化和/或影像学进展后转换至恩扎卢胺160 mg/d进行治疗,定时进行血清前列腺特异性抗原(PSA)等生化指标及影像学复查评估,观察并记录患者期间的不良事件、PSA应答及影像学进展情况。结果本组患者中位年龄72.4(57.0-84.0)岁。随访时间3-16个月:4例(21.05%)患者在转换至恩扎卢胺治疗期间PSA下降超过50%,7例(36.84%)PSA部分应答,8例PSA未出现下降;所有患者在服用恩扎卢胺后3-8(平均4.4)个月均出现PSA进展;14例(73.68%)患者出现影像学进展,平均进展时间5.8个月;18例(94.74%)患者出现疲乏症状,14例(73.68%)出现厌食症状,停用恩扎卢胺后症状缓解;疼痛进展12例,肿瘤相关死亡事件10例。结论阿比特龙耐药后的mCRPC患者进行恩扎卢胺替换治疗,对部分患者可有效延缓肿瘤进展,乏力、厌食是最常见的不良反应。

Objective To investigate the safety and efficacy of enzalutamide in metastatic castration-resistant prostate cancer(mCRPC)patients after abiraterone failure.Methods Data of 19 mCRPC patients with previous abiraterone failure treated with enzalutamide during Oct.2017 and Oct.2018 were collected.PSA/radiography data were collected.Adverse events,PSA response rate and radiography progression were evaluated during follow-up.Results The patients medicine age was 72.4(57.0-84.0)years.During the follow-up of 3-16 months,PSA decline>50%was observed in 4 patients(21.05%),7 patients(36.84%)had partial PSA decline and 8 patients had no PSA decline.All patients had PSA progression after taking Enzalutamide.The PSA progression time was 3-8 months,average 4.4 months.Radiography progression was observed in 14 patients(3.68%),average 5.8 months.Fatigue and anorexia were observed in 18 and 14 patients respectively,and adverse events were eased after enzalutamide discontinued.Pain progression(12 cases)and cancer-related death(10 cases)were recorded.Conclusion Enzalutamide relieved mCRPC progression in some patients with abiraterone failure.Fatigue and anorexia were the most common adverse events in these patients.