恩扎卢胺治疗阿比特龙耐药的转移性去势抵抗性前列腺癌患者的短期效果  

Short-term efficacy of enzalutamide in treatment of patients with abiraterone-resistant metastatic castration-resistant prostate cancer

作　　者：梅景昌 苏晓楠 姚榆 官丰菊[1] 张桂铭[1] MEI Jingchang;SU Xiaonan;YAO Yu;GUAN Fengju;ZHANG Guiming(Department of Urology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院泌尿外科,山东青岛266003 [2]邹城市人民医院泌尿外科

出　　处：《精准医学杂志》2025年第1期30-34,共5页Journal of Precision Medicine

基　　金：山东省自然科学基金项目(ZR2021MH354)。

摘　　要：目的探讨恩扎卢胺治疗阿比特龙耐药的转移性去势抵抗性前列腺癌(mCRPC)患者的短期效果和安全性。方法选取2020年12月—2022年4月就诊于青岛大学附属医院阿比特龙耐药的31例mCRPC患者为研究对象,均为阿比特龙耐药后再经恩扎卢胺继续治疗者。收集患者恩扎卢胺治疗前阿比特龙反应、阿比特龙抵抗情况,以及恩扎卢胺治疗后患者的前列腺特异性抗原(PSA)基线水平、PSA反应、PSA进展时间、影像学进展及不良反应发生情况。使用单因素及多因素Cox回归分析筛选患者恩扎卢胺治疗后发生PSA进展的相关危险因素。结果随访期间31例患者中,PSA有反应者12例(38.7%),PSA稳定者4例(12.9%),PSA无反应者15例(48.4%);PSA进展者22例(71.0%);影像学进展者20例(64.5%);28例(90.3%)患者出现不良反应,主要包括乏力和厌食,2例(6.5%)患者因不良反应停药;7例(22.5%)患者出现肿瘤相关死亡事件。单因素Cox分析表明,与确诊时血清PSA水平≤20μg/L者相比,血清PSA水平>20μg/L者发生PSA进展的风险更高,多因素Cox分析显示,确诊前列腺癌时更高的血清PSA水平是患者预后的独立危险因素。结论恩扎卢胺在部分阿比特龙耐药的mCRPC患者中显示出一定的短期疗效,多数患者仍面临疾病进展的风险,疲乏和厌食是常见不良反应,但不良反应相对较轻,多数患者可以耐受。Objective To investigate the short-term efficacy and safety of enzalutamide in the treatment of patients with abiraterone-resistant metastatic castration-resistant prostate cancer(mCRPC).Methods A total of 31 patients with abiraterone-resistant mCRPC who attended The Affiliated Hospital of Qingdao University from December 2020 to April 2022 were enrolled as subjects,and all these patients received treatment with enzalutamide after developing resistance to abiraterone.Related data were collected,including the response or resistance to abiraterone before enzalutamide treatment,prostate-specific antigen(PSA)level at baseline,PSA response,time to PSA progression,radiographic progression,and adverse reactions after enzalutamide treatment.The univariate and multivariate Cox regression analyses were used to identify the risk factors for PSA progression after enzalutamide treatment.Results Among the 31 patients during follow-up,12(38.7%)had PSA response,4(12.9%)had stable PSA,and 15(48.4%)had no response to PSA.There were 22 patients(71.0%)with PSA progression and 20(64.5%)with radiographic progression.Of all patients,28(90.3%)experienced adverse reactions,mainly weakness and anorexia,and 2 patients(6.5%)withdrew from drug therapy due to adverse reactions;7 patients(22.5%)experienced tumor-related death.The univariate Cox analysis showed that compared with the patients with a serum PSA level of≤20μg/L at the time of diagnosis,the patients with a serum PSA level of>20μg/L had a higher risk of PSA progression,and the multivariate Cox regression analysis showed that a higher serum PSA level at the time of a confirmed diagnosis of prostate cancer was an independent risk factor for the prognosis of patients.Conclusion Enzalutamide has a certain short-term efficacy in some mCRPC patients resistant to abiraterone,but the majority of patients still face the risk of disease progression.Weakness and anorexia are common adverse reactions,but most adverse reactions are relatively mild and can be tolerated by most patients.

关 键 词：前列腺肿瘤 去势难治性 阿比特龙 抗药性 肿瘤 恩扎卢胺 前列腺特异抗原 雄激素拮抗药 治疗结果 

分 类 号：R737.25[医药卫生—肿瘤]