Early Prostate-Specific Antigen (PSA) Change at Four Weeks of the First-Line Treatment Using Abiraterone and Enzalutamide Could Predict Early/Primary Resistance in Metastatic Castration-Resistant Prostate Cancer.
Early Prostate-Specific Antigen (PSA) Change at Four Weeks of the First-Line Treatment Using Abiraterone and Enzalutamide Could Predict Early/Primary Resistance in Metastatic Castration-Resistant Prostate Cancer.
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DOI：
10.3390/cancers13030526
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发表时间：
2021-01-30
期刊：
影响因子：
5.2
通讯作者：
Azuma H
中科院分区：
文献类型：
--
作者：
Uchimoto T;Komura K;Fukuokaya W;Kimura T;Takahashi K;Nishimura K;Nakamori K;Fujiwara Y;Matsunaga T;Tsutsumi T;Tsujino T;Maenosono R;Yoshikawa Y;Taniguchi K;Tanaka T;Uehara H;Ibuki N;Hirano H;Nomi H;Takahara K;Inamoto T;Egawa S;Azuma H
血清前列腺特异性抗原（PSA）水平是前列腺癌最有价值的生物标志物。本研究使用 254 名 mCRPC 患者的多机构队列数据集，调查了一线雄激素信号抑制剂 (ASI) 在 4 周内实现 PSA 下降 > 30% 的预测价值。 4 周时 PSA 下降 >30% 是总生存期 (OS) 的独立预测因素。有趣的是，在 4 周时 PSA 下降未达到 >30% 的患者中，最终在 12 周时观察到 30.9% 的患者实现了 PSA 下降 >30%。为了确定在一线治疗的 4 周内未实现 PSA 下降超过 30% 的 97 名患者中区分患者生存的变量，进行了多变量分析。 CRPC 前雄激素剥夺治疗持续时间 < 12 个月和东部肿瘤合作组表现状态≥ 1 被确定为这些患者 OS 缩短的独立预测因素。雄激素信号抑制剂（ASI）的早期或原发耐药性的鉴定对于转移性去势抵抗性前列腺癌（mCRPC）的治疗具有重要价值。本研究评估了 mCRPC 患者一线 ASI 治疗数周内前列腺特异性抗原 (PSA) 反应的预测价值。回顾性分析了总共 254 例在一线治疗中接受 ASI（醋酸阿比特龙：AA 和恩杂鲁胺：Enz）治疗的患者。根据治疗开始后 4 周和 12 周时 PSA 下降 >30% 的情况对患者进行分层。治疗 4 周后，157 名患者 (61.8%) PSA 较基线下降超过 30%。此后，177 名患者 (69.7%) 在治疗 12 周时 PSA 下降超过 30%。多变量分析显示 4 周时 PSA 下降超过 30%，作为总生存 (OS) 的独立预测因子。我们注意到，97 名患者中，有 30 名 (30.9%) 在 4 周时 PSA 下降未达到 >30%，因此在 12 周时 PSA 下降 >30%，并且与 147 名患者在 4 周和 12 周时 PSA 下降 >30% 相比，三年 OS 率相当有利。为了确定 97 名患者在 4 周内 PSA 下降未达到 >30% 的情况下区分患者生存的变量，进行了多变量分析。 CRPC 前雄激素剥夺治疗持续时间≤ 12 个月和东部肿瘤合作组表现状态≥ 1 被确定为这些患者 OS 缩短的独立预测因素。这些数据提供了在一线 ASI 治疗 4 周后，如果未观察到 4 周 PSA 下降超过 30%，应尽早转换治疗的概念，特别是对于 ADT 效果中等且体力状态较差的患者。
Serum prostate-specific antigen (PSA) level is the most valuable biomarker in prostate cancer. This study investigates the predictive value of achieving >30% PSA decline at four weeks of first-line androgen signaling inhibitors (ASIs) using a multi-institutional cohort dataset of 254 mCRPC patients. The achievement of >30% PSA decline at four weeks is an independent predictor for overall survival (OS). Interestingly, in patients who did not achieve >30% PSA decline at four weeks—an achievement of the >30% PSA decline at 12 weeks is eventually observed in 30.9% of those patients. To identify the variables that discriminate the patient survival in 97 patients without achieving >30% PSA decline at four weeks of the first-line treatment, a multivariate analysis is conducted. The duration of androgen deprivation therapy before CRPC < 12 months and Eastern Cooperative Oncology Group Performance Status ≥ 1 are identified as independent predictors for shorter OS for those patients. The identification of early or primary resistance to androgen signaling inhibitors (ASIs) is of great value for the treatment of metastatic castration-resistant prostate cancer (mCRPC). This study evaluates the predictive value of prostate-specific antigen (PSA) response at dour weeks of first-line ASIs treatment for mCRPC patients. A total of 254 patients treated with ASIs (abiraterone acetate: AA and enzalutamide: Enz) at the first-line treatment are retrospectively analyzed. Patients are stratified according to the achievement of >30% PSA decline at 4 and 12 weeks from the treatment initiation. At four weeks of the treatment, 157 patients (61.8%) achieved >30% PSA decline from the baseline. Thereafter, 177 patients (69.7%) achieved >30% PSA decline at 12 weeks of the treatment. A multivariate analysis exhibits >30% PSA decline at four weeks as an independent predictor for overall survival (OS). We note that 30 of 97 (30.9%) patients who did not achieve >30% PSA decline at four weeks consequently achieved >30% PSA decline at 12 weeks, and had a comparable favorable three years OS rate as the 147 patients achieving >30% PSA decline at both 4 and 12 weeks. To identify the variables that discriminate the patient survival in 97 patients without achieving >30% PSA decline at four weeks, a multivariate analysis is performed. The duration of androgen deprivation therapy before CRPC ≤ 12 months and Eastern Cooperative Oncology Group Performance Status ≥ 1 are identified as independent predictors for shorter OS for those patients. These data offer a concept of early treatment switch after four weeks of first-line ASIs when not observing >30% PSA decline at four weeks—particularly in patients with a modest effect of ADT and poor performance status.
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DOI：
10.1158/1078-0432.ccr-16-1070
发表时间：
2017-02-01
期刊：
Clinical cancer research : an official journal of the American Association for Cancer Research
影响因子：
--
作者：
Qu F;Xie W;Nakabayashi M;Zhang H;Jeong SH;Wang X;Komura K;Sweeney CJ;Sartor O;Lee GM;Kantoff PW
通讯作者：
Kantoff PW
影响因子：
8.4
作者：
Eisenhauer, E. A.;Therasse, P.;Verweij, J.
通讯作者：
Verweij, J.
影响因子：
158.5
作者：
Parker, C.;Nilsson, S.;Sartor, O.
通讯作者：
Sartor, O.
影响因子：
11.5
作者：
Chakraborty, Goutam;Armenia, Joshua;Kantoff, Philip W.
通讯作者：
Kantoff, Philip W.
影响因子：
5.4
作者：
Lorente, David;Ravi, Praful;de Bono, Johann
通讯作者：
de Bono, Johann