Prior switching to a second-line nonsteroidal antiandrogen does not impact the therapeutic efficacy of abiraterone acetate in patients with metastatic castration-resistant prostate cancer： a real-world retrospective study  

作　　者：Jin-G Zhao Jian-Dong Liu Peng-Fei Shen Xin Tang Guang-Xi Sun Xing-Ming Zhang Jun-Ru Chen Kun-Peng Shul Ming Shi Hao Zeng Jin-G Zhao;Jian-Dong Liu;Peng-Fei Shen;Xin Tang;Guang-Xi Sun;Xing-Ming Zhang;Jun-Ru Chen;Kun-Peng Shu;Ming Shi;Hao Zeng(Department of Urology,Institute of Urology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Oncology,West China Hospital,Sichuan University,Chengdu 610041,China.)

机构地区：[1]Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China [2]Department of Oncology, West China Hospital, Sichuan University, Chengdu 610041, China

出　　处：《Asian Journal of Andrology》2018年第6期545-550,共6页亚洲男性学杂志（英文版）

基　　金：This work was supported by the National Natural Science Foundation of China （NSFC 81672547, 81402110, and 81272820）; Science and Technology Support Program of Sichuan Province （2015SZ0142）; and the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University.

摘　　要：Even in the era of novel targeted agents, switching to a second-line nonsteroidal antiandrogen （NSAA） is still widely used in treating metastatic castration-resistant prostate cancer （mCRPC）, especially in undeveloped countries. However, whether prior treatment with a second-line NSAA would impact the efficacy of abiraterone acetate （Abi） remains uncertain, in the current study, 87 mCRPC patients treated with Abi were analyzed. Among them, 21 were treated with a second-line NSAA （from bicalutamide to flutamide） before receiving abiraterone, while the remaining 66 received Abi directly. Therapeutic efficacy of Abi was compared between those with and without prior second-line NSAA using Kaplan-Meier curves, log-rank test, and Cox regression models. The therapeutic efficacy of Abi was similar between those with or without the prior switching treatment of flutamide, in terms of either prostate-specific antigen progression-free survival （PSA-PFS, 5.5 vs 5.6 months, P = 0.967）, radiographic progression-free survival （rPFS, 12.8 vs 13.4 months, P = 0.508）, overall survival （OS, not reached vs 30.6 months, P = 0.606）, or PSA-response rate （71.4% [15121] vs 60.6% [40166], P = 0.370）. This is the first time that the impact of prior switching of treatment to a second-line NSAA on the efficacy of Abi in mCRPC patients has been addressed. Our data support that, use of prior sequential bicalutamide and flutamide does not seem to preclude response to abiraterone, although larger cohort studies and, ideally, a randomized controlled trial are needed. These findings will facilitate doctors＇ decision-making in the treatment of mCRPC patients, especially for those with previous experience of switching NSAA second-line treatments in the clinic.Even in the era of novel targeted agents, switching to a second-line nonsteroidal antiandrogen （NSAA） is still widely used in treating metastatic castration-resistant prostate cancer （mCRPC）, especially in undeveloped countries. However, whether prior treatment with a second-line NSAA would impact the efficacy of abiraterone acetate （Abi） remains uncertain, in the current study, 87 mCRPC patients treated with Abi were analyzed. Among them, 21 were treated with a second-line NSAA （from bicalutamide to flutamide） before receiving abiraterone, while the remaining 66 received Abi directly. Therapeutic efficacy of Abi was compared between those with and without prior second-line NSAA using Kaplan-Meier curves, log-rank test, and Cox regression models. The therapeutic efficacy of Abi was similar between those with or without the prior switching treatment of flutamide, in terms of either prostate-specific antigen progression-free survival （PSA-PFS, 5.5 vs 5.6 months, P = 0.967）, radiographic progression-free survival （rPFS, 12.8 vs 13.4 months, P = 0.508）, overall survival （OS, not reached vs 30.6 months, P = 0.606）, or PSA-response rate （71.4% [15121] vs 60.6% [40166], P = 0.370）. This is the first time that the impact of prior switching of treatment to a second-line NSAA on the efficacy of Abi in mCRPC patients has been addressed. Our data support that, use of prior sequential bicalutamide and flutamide does not seem to preclude response to abiraterone, although larger cohort studies and, ideally, a randomized controlled trial are needed. These findings will facilitate doctors＇ decision-making in the treatment of mCRPC patients, especially for those with previous experience of switching NSAA second-line treatments in the clinic.

关 键 词：ABIRATERONE ANTIANDROGEN castration-resistant prostate cancer FLUTAMIDE 

分 类 号：TQ466.5[化学工程—制药化工] S854.5[农业科学—临床兽医学]