Bicalutamide for advanced prostate cancer: The natural versus treated history of disease
Bicalutamide for advanced prostate cancer: The natural versus treated history of disease
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DOI：
10.1200/jco.1997.15.8.2928
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发表时间：
1997-08-01
影响因子：
45.3
通讯作者：
Schwartz, M
中科院分区：
文献类型：
--
作者：
Scher, HI;Liebertz, C;Schwartz, M
目的：为了确定比卡鲁胺200 mg在不同激素敏感性的前列腺癌患者中的治疗效果，方法：对进行性前列腺癌患者每日给予比卡鲁胺200 mg治疗。在治疗前，根据先前的激素暴露和血清睾酮水平将患者的肿瘤分为雄激素依赖组和雄激素非依赖组。还考虑了既往暴露于氟替卡松和对氟替卡松停药的反应。根据治疗后前列腺特异性抗原（PSA）、可测量疾病和放射性核素骨扫描的变化独立报告结局。结果因既往激素暴露而异，因为雄激素依赖性肿瘤进展的患者中有更高比例的患者显示治疗后PSA下降超过50%或超过80%，可测量的疾病消退，和改善放射性核素骨扫描比雄激素非依赖性进展的患者。在雄激素非依赖性进展类别中，在既往接受过氟替卡松治疗的患者中观察到临床获益，与氟替卡松停药的反应无关。单独使用促性腺激素释放激素（GnRH）类似物治疗进展的患者的反应比例较低，而两种或更多种激素治疗后进展的患者则无反应。总体而言，药物耐受性良好。比卡鲁托胺单药治疗进展后，三分之一的雄激素依赖性进展的患者响应药物去势与GnRH analog.Conclusion：分类患者肿瘤的基础上，以前的激素暴露允许更精确的估计一个特定的激素治疗的潜在利益为个别患者。通过独立地报告药物对疾病的每个参数的影响，进一步提高了精确度。雄激素非依赖性进展患者的结局差异表明，给予的特定激素治疗和对该治疗的反应可以影响复发肿瘤的生物学和对后续治疗的敏感性。氟替卡松治疗进展后对比卡鲁胺的敏感性值得进一步研究。(C)1997年，美国临床肿瘤学会。
Purpose: To determine the therapeutic effects of bicalutamide 200 mg in patients with prostate cancers of different hormone sensitivities.Methods: Patients with progressive prostate cancer were treated with bicalutamide 200 mg daily. Before treatment, patients' tumors were classified on the basis of prior hormone exposure and by serum testosterone levels into androgen-dependent and androgen-independent groups. Prior exposure to flutamide and response to flutamide withdrawal was also considered. Outcomes were reported independently on the basis of posttherapy changes in prostate-specific antigen (PSA), measurable disease, and radionuclide bone scans.Results: Outcomes varied by prior hormone exposure as a higher proportion of patients with progression of androgen-dependent tumors showed posttherapy PSA decreases of more than 50% or more than 80%, measurable disease regression, and improvement on radionuclide bone scans than did patients with androgen-independent progression. Within the category of androgen-independent progression, clinical benefit was observed in patients who had previously progressed on flutamide, independent of the response to flutamide withdrawal. Patients who had progressed on a gonadotropin-releasing hormone (GnRH) analog alone had a low response proportion, whereas those who progressed after two or more hormone therapies did not respond. Overall, the drug was well tolerated. After progression on bicalutomide monotherapy, one third of patients with androgen-dependent progression responded to medical castration with a GnRH analog.Conclusion: Classifying patient tumors on the basis of prior hormone exposure permits a more precise estimate of the potential benefit of a specific hormone therapy for the individual patient. The precision is further increased by reporting the effects of a drug on each parameter of disease independently. The difference in outcomes for patients with androgen-independent progression suggests that the specific hormone therapy administered and the response to that therapy can influence the biology of the relapsing tumor and the sensitivity to subsequent therapies. The sensitivity to bicalutamide after progression on flutamide deserves further study. (C) 1997 by American Society of Clinical Oncology.