卡铂+依托泊苷联合阿比特龙+强的松治疗转移性去势抵抗性前列腺患者的疗效和安全性

Efficacy and safety of carboplatin+etoposide regimens combined with abiraterone+prednisone in patients with metastatic castration-resistant prostate cancer

目的:评价转移性去势抵抗性前列腺癌(metastatic castration-resistant prostate cancer,mCRPC)患者多西他赛+强的松(docetaxel+prednisone,DP)方案化疗和(或)新型内分泌治疗(novel hormone therapy,NHT)进展后应用卡铂+依托泊苷(carboplatin+etoposide,CE)方案联合阿比特龙+强的松(abiraterone+prednisone,AAP)治疗的疗效和安全性。方法:回顾性分析mCRPC患者接受DP方案化疗和(或)NHT治疗后进展,进行CE方案+AAP治疗,每3周为1周期×6周期。观察指标包括前列腺特异性抗原(prostate specific antigen,PSA)缓解率、PSA进展时间(time to PSA progression,TTPP)、影像学无进展生存期(radiographic progression-free survival,rPFS)、PSA下降30%、PSA下降90%、客观缓解率和总生存期(overall survival,OS)。结果:2019年3月至2024年2月,在北京市朝阳区桓兴肿瘤医院和中国医学科学院肿瘤医院收治的符合条件的37例mCRPC患者,进展后应用CE方案联合AAP方案治疗,中位年龄66.0岁,中位随访12.0(3.0~57.0)个月,中位治疗4个周期。PSA缓解率42.1%,中位TTPP 4.0个月,中位rPFS 8.9个月,中位OS 15.0个月。客观缓解率24.3%,PSA下降30%者占59.5%,PSA下降90%者占16.2%;安全性方面,3级及以上不良反应10例。结论:联合应用CE方案和AAP对初始DP方案化疗和(或)NHT治疗失败的去势抵抗性前列腺癌(castration-resistant prostate cancer,CRPC)患者显示出良好的临床疗效和耐受性,但需要更多的样本量和随访时间进一步验证其疗效。

Objective:To assess the efficacy and toxicities of carboplatin+etoposide(CE)regimens combined with abiraterone+prednisone(AAP)in patients with metastatic castration-resistant prostate cancer(mCRPC)after progression with docetaxel+prednisone(DP)regimens chemotherapy and novel hormone therapy(NHT).Methods:Retrospective analysis of mCRPC treated with DP regimens chemotherapy and/or NHT after progression,received CE regimens with AAP every 3 weeks for one cycle×6 cycles.The outcome were prostate specific antigen(PSA)response rate,time to PSA progression(TTPP),radiographic progression-free survival(rPFS),30%reduction in PSA,90%reduction in PSA,the objective response remission rate and overall survival(OS).Results:From March 2019 to February 2024,37 eligible mCRPC patients were admitted to Cancer Hospital of Huanxing Chaoyang District Beijing and National Cancer Center/National Cancer Clinical Research Center/Cancer Hospital.After progression,CE regimens combined with AAP regimens was used for treatment.The median follow-up was 12.0(3.0-57.0)months.The median treatment cycle was 4 cycles.The PSA response rate was 42.1%.The median TTPP was 4.0 months;the median rPFS was 8.9 months and the median OS was 15.0 months.The objective remission rate was 24.3%,the proportion of 30%decrease in PSA was 59.5%,and the proportion of 90%decrease in PSA was 16.2%.As for treatment side effects,10 cases had grade 3 or higher adverse reactions.Conclusions:CE regimens combined with AAP for mCRPC patients who failed DP regimens chemotherapy and/or NHT initially showed good clinical efficacy and tolerability.Additional sample size and follow-up time are needed to further validate the efficacy.