Alternative nonsteroidal antiandrogen therapy for advanced prostate cancer that relapsed after initial maximum androgen blockade
Alternative nonsteroidal antiandrogen therapy for advanced prostate cancer that relapsed after initial maximum androgen blockade
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DOI：
10.1016/j.juro.2008.05.045
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发表时间：
2008-09-01
影响因子：
6.6
通讯作者：
Miki, Tsuneharu
中科院分区：
文献类型：
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作者：
Suzuki, Hiroyoshi;Okihara, Koji;Miki, Tsuneharu
目的：大型荟萃分析表明，最大雄激素阻断与非甾体类抗雄激素治疗晚期前列腺癌的生存获益，虽然它仍然存在争议。此外，我们和其他人报道了二线激素治疗前列腺癌的有效性，复发后最初的激素治疗。然而，很少有临床证据表明后一种治疗策略的有效性。因此，在日本的这项多中心试验中，我们分析了从1变更为2后的临床结局。非甾体抗雄激素，即比卡鲁胺，氟替卡松和氟替卡松比卡鲁胺，晚期前列腺癌复发后，最初的最大雄激素block.Materials和方法：这项研究包括232例晚期前列腺癌谁最初治疗的最大雄激素阻断，包括手术或药物去势结合非甾体抗雄激素。如果患者在一线治疗期间复发，我们停用抗雄激素并评估患者的抗雄激素戒断综合征。然后，我们管理的替代抗雄激素，并评估其effect.Results：抗雄激素戒断综合征的发病率后，最初的最大雄激素阻断比卡鲁胺和氟罗沙坦分别为15.5%和12.8%。停用抗雄激素药物后前列腺特异性抗原降低是一个预后因素。非甾体类抗雄激素作为初始最大雄激素阻断后复发患者的替代治疗，作为二线最大雄激素阻断有效（前列腺特异性抗原降低大于50%）。在232例患者中，142例（61.2%）显示前列腺特异性抗原对替代抗雄激素的反应降低。这些反应者有显着更好的生存率比nonresponses，表明二线治疗的反应性预测增加survival.Conclusions：最大雄激素阻断后，与替代非甾体抗雄激素是有效的晚期前列腺癌复发后，最初的最大雄激素阻断。即使对二线最大雄激素阻断治疗有部分反应，也能提高生存率。我们的数据支持二线治疗方案的反应者是雄激素非依赖性的，但仍然是睾丸敏感的。
Purpose: Large meta-analyses have documented that maximum androgen blockade with nonsteroidal antiandrogens for advanced prostate cancer confers survival benefits, although it remains controversial. Also, we and others have reported the effectiveness of second line hormonal therapy for prostate cancer that relapses after initial hormone therapy. However, there is little clinical evidence of the effectiveness of the latter treatment strategy. Therefore, in this multicenter trial in Japan we analyzed clinical outcomes following alternative changing from 1. nonsteroidal antiandrogen to another, ie bicalutamide to flutamide and flutamide to bicalutamide, for advanced prostate cancer that relapsed after initial maximum androgen blockade.Materials and Methods: The study included 232 patients with advanced prostate cancer who were initially treated with maximum androgen blockade, including surgical or medical castration combined with nonsteroidal antiandrogens. If a patient relapsed while on first line therapy, we discontinued antiandrogen and evaluated the patient for antiandrogen withdrawal syndrome. We then administered an alternative antiandrogen and evaluated its effect.Results: The incidence of antiandrogen withdrawal syndrome after initial maximum androgen blockade was 15.5% for bicalutamide and 12.8% for flutamide. A prostate specific antigen decrease after antiandrogen withdrawal was a prognostic factor. Nonsteroidal antiandrogens as alternative therapy in patients with relapse after the initial maximum androgen blockade were effective (prostate specific antigen decrease greater than 50%) as second line maximum androgen blockade. Of 232 patients 142 (61.2%) showed a prostate specific antigen decrease in response to an alternative antiandrogen. These responders had significantly better survival than nonresponders, suggesting that responsiveness to second line therapy predicts increased survival.Conclusions: Following maximum androgen blockade with an alternative nonsteroidal antiandrogen is effective for advanced prostate cancer that has relapsed after initial maximum androgen blockade. Even a partial response to second line maximum androgen blockade was associated with improved survival. Our data support the notion that responders to second line regimens are androgen independent but still hormonally sensitive.