Interrogating Metastatic Prostate Cancer Treatment Switch Decisions: A Multi-institutional Survey
Interrogating Metastatic Prostate Cancer Treatment Switch Decisions: A Multi-institutional Survey
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DOI：
10.1016/j.euf.2016.09.005
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发表时间：
2018-03-01
影响因子：
5.4
通讯作者：
de Bono, Johann
中科院分区：
文献类型：
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作者：
Lorente, David;Ravi, Praful;de Bono, Johann
背景：评估转移性去势抵抗性前列腺癌（mCRPC）的治疗反应仍然具有挑战性。基于前列腺特异性抗原（PSA）和临床和放射学生物标志物的共识标准并不一致。循环肿瘤细胞（CTC）计数可以告知预后和反应，但不是常规使用。目的：评估生物标志物的使用和当前mCRPC治疗中临床决策的趋势。设计、设置和参与者：由治疗mCRPC的医生完成了一份23部分的在线问卷。结果测量和统计分析：结果以回答每个选项的医生比例（%）表示。结果和局限性：共有118名医生（22.1%）回答。其中，69.4%治疗≥ 50例mCRPC患者/年。给予卡巴他赛4个或更少疗程的医生（27.9%）多于多西他赛（10.4%），仅骨疾病和实体瘤疗效评价标准（RECIST）可评价疾病之间的疗程数无显著差异。约74.5%的受访者认为目前的生物标志物可用于监测疾病，但只有39.6%的人在临床实践中使用前列腺癌工作组（PCWG 2）标准。55.7%的患者认为PSA是一种重要的生物标志物，但只有41.4%的患者在12周前放弃了PSA的变化，只有39.4%的患者能够根据PCWG 2识别骨扫描进展。绝大多数医生（90.5%）认为临床进展对于转换治疗很重要。认为生物标志物重要的比例为：RECIST为71.6%，骨扫描为47.4%，CTC为23.2%，PSA为21.1%。尽管53.1%的患者承认基线CTC计数具有预后意义，但仅33.7%的患者仅使用CTC变化来改变仅骨疾病患者的治疗。在使用CTC计数的主要挑战是获得CTC技术（84.7%），成本（74.5%），和效用的不确定性作为一个响应indicator（58.2%）。结论：一个显着比例的医生停止治疗mCRPC前12周，引起关注反应评估不足。许多医生发现目前的生物标志物是有用的，但大多数依赖于症状来驱动治疗转换decisions，这表明需要更精确的生物标志物.Patient摘要：在这份报告中，我们分析了由118名前列腺癌专家完成的评估临床决策工具的问卷调查结果。我们发现，大多数医生更倾向于临床进展，而不是前列腺特异性抗原或成像，并且前列腺癌工作组建立的标准没有被广泛使用。(C)2016年欧洲泌尿外科协会。由爱思唯尔公司出版
Background: Evaluation of responses to treatment for metastatic castration-resistant prostate cancer (mCRPC) remains challenging. Consensus criteria based on prostate-specific antigen (PSA) and clinical and radiologic biomarkers are inconsistently utilized. Circulating tumor cell (CTC) counts can inform prognosis and response, but are not routinely used.Objective: To evaluate the use of biomarkers and trends in clinical decision-making in current mCRPC treatment.Design, setting, and participants: A 23-part online questionnaire was completed by physicians treating mCRPC.Outcome measures and statistical analysis: Results are presented as the proportion (%) of physicians responding to each of the options. Weused chi(2) and Fisher's tests to compare differences.Results and limitations: A total of 118 physicians (22.1%) responded. Of these, 69.4% treated >= 50 mCRPC patients/year. More physicians administered four or fewer courses of cabazitaxel (27.9%) than for docetaxel (10.4%), with no significant difference in the number of courses between bone-only disease and Response Evaluation Criteria in Solid Tumours (RECIST)-evaluable disease. Some 74.5% of respondents considered current biomarkers useful for monitoring disease, but only 39.6% used the Prostate Cancer Working Group (PCWG2) criteria in clinical practice. PSA was considered an important biomarker by 55.7%, but only 41.4% discarded changes in PSA before 12 wk, and only 39.4% were able to identify bone-scan progression according to PCWG2. The vast majority of physicians (90.5%) considered clinical progression to be important for switching treatment. The proportion considering biomarkers important was 71.6% for RECIST, 47.4% for bone scans, 23.2% for CTCs, and 21.1% for PSA. Although 53.1% acknowledged that baseline CTC counts are prognostic, only 33.7% would use CTC changes alone to switch treatment in patients with bone-only disease. The main challenges in using CTC counts were access to CTC technology (84.7%), cost (74.5%), and uncertainty over utility as a response indicator (58.2%).Conclusions: A significant proportion of physicians discontinue treatment for mCRPC before 12 wk, raising concerns about inadequate response assessment. Many physicians find current biomarkers useful, but most rely on symptoms to drive treatment switch decisions, suggesting there is a need for more precise biomarkers.Patient summary: In this report we analyse the results of a questionnaire evaluating tools for clinical decision-making completed by 118 prostate cancer specialists. We found that most physicians favour clinical progression over prostate-specific antigen or imaging, and that criteria established by the Prostate Cancer Working Group are not widely used. (C) 2016 European Association of Urology. Published by Elsevier B.V.