首剂促性腺激素释放激素拮抗剂转换激动剂疗法在转移性前列腺癌中的应用探索  

Efficacy of initial luteinizing hormone-releasing hormone agonists transition to luteinizing hormone-releasing hormone agonists therapy in metastatic prostate cancer

作　　者：陈翔 陈伟 王杭 郭剑明 徐磊 CHEN Xiang;CHEN Wei;WANG Hang;GUO Jianming;XU Lei(Department of Urology,Zhongshan Hospital,Fudan University,Shanghai,200032,China)

机构地区：[1]复旦大学附属中山医院泌尿外科,上海200032

出　　处：《临床泌尿外科杂志》2024年第10期858-861,共4页Journal of Clinical Urology

基　　金：复旦大学附属中山医院临床研究项目(No:2018ZSLC32)。

摘　　要：目的:探索首剂促性腺激素释放激素(luteinizing hormone-releasing hormone,LHRH)拮抗剂后续转换激动剂方案在转移性前列腺癌中的短期疗效。方法:在转移性激素敏感性前列腺癌患者中,分为地加瑞克组及对照组进行回顾性分析。地加瑞克组采用首剂LHRH拮抗剂地加瑞克240 mg皮下注射,后续转换为LHRH激动剂(亮丙瑞林、戈舍瑞林或曲普瑞林)治疗方案,对照组采用LHRH激动剂治疗方案(首次注射时联用比卡鲁胺2周)。通过检测治疗后4周及12周血清前列腺特异性抗原(prostate specific antigen,PSA)与睾酮,比较2种治疗方案对血清PSA及睾酮控制的优劣。结果:每组分别纳入27例转移性前列腺癌患者。地加瑞克组及对照组间基线年龄、PSA中位值、伴发慢性疾病比例比较,差异均无统计学意义。治疗后4周,地加瑞克组睾酮中位值低于对照组(0.2 nmol/L vs 0.4 nmol/L,P=0.031),且地加瑞克组88.9%的患者达到了更低的睾酮水平(<0.7 nmol/L),比例高于对照组(63.0%),对照组2例患者未达到去势水平睾酮,差异有统计学意义(P=0.026);PSA中位值比较差异无统计学意义(26.2 ng/mL vs 23.2 ng/mL,P=0.462)。治疗后12周,地加瑞克组睾酮中位值仍低于对照组(0.087 nmol/L vs 0.100 nmol/L,P=0.024);PSA中位值比较差异无统计学意义(2.4 ng/mL vs 4.3 ng/mL,P=0.180)。结论:相较于对照组,地加瑞克组治疗后4周及12周血清睾酮可降至更低水平,可能更有利于高转移负荷前列腺癌患者的肿瘤控制。Objective To explore short-term efficacy of initial luteinizing hormone-releasing hormone(LHRH)antagonists transition to LHRH agonists therapy in patients with metastatic prostate cancer.Methods Patients with metastatic hormone-sensitive prostate cancer were divided into degarelix group and control group.Data were retrospectively analyzed.Intervention for degarelix group was initial injection of degarelix 240 mg,followed by LHRH agonists(leuprorelin,goserelin,or triptorelin)monthly injection.Control group was injected LHRH agonists combined with oral bicalutamide for 2 weeks.Serum prostate specific antigen(PSA)and testosterone were tested four weeks and twelve weeks after the treatment to compare the efficacy between the two interventions.Results Each group enrolled 27 patients,with balanced age,median PSA,and comorbidities.In week 4,median testosterone level in degarelix group was lower(0.2 nmol/L vs 0.4 nmol/L,P=0.031),but median PSA level was comparable(26.2 ng/mL vs 23.2 ng/mL,P=0.462).Lower level of testosterone(<0.7 nmol/L)was achieved in 88.9%patients of degarelix group,while 63.0%patients of control group(P=0.026).Two patients in control group failed to achieve castration level of testosterone.In week 12,median testosterone level in degarelix group was still lower(0.087 nmol/L vs 0.1 nmol/L,P=0.024),but median PSA level showed no significance between two groups(2.4 ng/mL vs 4.3 ng/mL,P=0.180).Conclusion Degarelix group achieved lower testosterone level in week 4 and week 12,so this regime may be a better choice for patients with high-burden metastatic prostate cancer.

关 键 词：前列腺癌 内分泌治疗 促性腺激素释放激素拮抗剂 疗效 

分 类 号：R737.25[医药卫生—肿瘤]