■醋酸阿比特龙和恩扎鲁他胺被推荐作为转移性去势耐药前列腺癌(mCRPC)的首选治疗方法,但由于缺乏头对头临床试验,其相对疗效的差异尚不清楚.需要明确的指导来做出明智的mCRPC治疗选择。
■比较使用醋酸阿比特龙或恩扎鲁他胺治疗的mCRPC患者的临床结果。
■这次回顾展,多中心队列研究纳入了2014年1月1日至2022年10月30日期间美国退伍军人事务部卫生保健系统中开始使用醋酸阿比特龙或恩扎鲁他胺治疗的mCRPC患者.
■醋酸阿比特龙或恩扎鲁他胺。
■该研究使用治疗权重的逆概率来平衡开始使用醋酸阿比特龙或恩扎鲁他胺的患者之间的基线特征,并评估总生存期(OS)的受限平均生存时间(RMST)差异,前列腺癌特异性生存率(PCS),下一次治疗转换或死亡的时间(TTS),以及治疗开始后不同时间点的前列腺特异性抗原(PSA)应答时间(TTR)。
■该研究包括5779名患者(中位年龄,74.42年[IQR,68.94-82.14年])。中位随访时间为38至60个月。服用恩杂鲁胺的患者平均OS比服用醋酸阿比特龙的患者长。RMST为24.29个月(95%CI,23.58-24.99个月)和23.38个月(95%CI,22.85-23.92个月),分别,4年RMST差异为0.90个月(95%CI,0.02-1.79个月)。同样,服用恩杂鲁胺的患者TTS和TTR得到改善,TTS的RMST为4年,为1.95个月(95%CI,0.92-2.99个月),TTR的RMST为3.57个月(95%CI,1.76-5.38个月)。对于PCS,2年时RMST延长0.48个月(95%CI,0.01-0.95个月).亚组检查发现,恩杂鲁胺开始与先前没有多西他赛治疗的患者(1.14个月;95%CI,0.19-2.10个月)和PSA倍增时间为3个月或更长时间(2.23个月;95%CI,0.81-3.66个月)的患者OS中的RMST更长相关,但在先前多西他赛的患者中(-0.25个月;95%CI,比1.
■在这项mCRPC患者的队列研究中,恩杂鲁胺的开始与OS的微小但具有统计学意义的改善有关,PCS,TTS,和TTR与乙酸阿比特龙的引发相比。改善在短期结果中更为突出,包括TTS和TTR,以及先前没有多西他赛或PSA倍增时间超过3个月的患者亚组。
UNASSIGNED: Abiraterone acetate and enzalutamide are recommended as preferred treatments for metastatic castration-resistant prostate cancer (mCRPC), but differences in their relative efficacy are unclear due to a lack of head-to-head clinical trials. Clear guidance is needed for making informed mCRPC therapeutic choices.
UNASSIGNED: To compare clinical outcomes in patients with mCRPC treated with abiraterone acetate or enzalutamide.
UNASSIGNED: This retrospective, multicenter cohort study included patients with mCRPC in the US Department of Veterans Affairs health care system who initiated treatment with abiraterone acetate or enzalutamide between January 1, 2014, and October 30, 2022.
UNASSIGNED: Abiraterone acetate or enzalutamide.
UNASSIGNED: The study used inverse probability of treatment weighting to balance baseline characteristics between patients initiating abiraterone acetate or enzalutamide and evaluated restricted mean survival time (RMST) differences in overall survival (OS), prostate cancer-specific survival (PCS), time to next treatment switching or death (TTS), and time to prostate-specific antigen (PSA) response (TTR) at different time points after treatment initiation.
UNASSIGNED: The study included 5779 patients (median age, 74.42 years [IQR, 68.94-82.14 years]). Median follow-up was between 38 and 60 months. Patients initiating enzalutamide on average had longer OS than those initiating abiraterone acetate, with RMSTs of 24.29 months (95% CI, 23.58-24.99 months) and 23.38 months (95% CI, 22.85-23.92 months), respectively, and a difference in RMST of 0.90 months (95% CI, 0.02-1.79 months) at 4 years. Similarly, TTS and TTR were improved in patients initiating enzalutamide, with an RMST at 4 years of 1.95 months (95% CI, 0.92-2.99 months) longer for TTS and 3.57 months (95% CI, 1.76-5.38 months) shorter for TTR. For PCS, the RMST at 2 years was 0.48 months (95% CI, 0.01-0.95 months) longer. An examination of subgroups identified that enzalutamide initiation was associated with longer RMST in OS among patients without prior docetaxel treatment (1.14 months; 95% CI, 0.19-2.10 months) and in those with PSA doubling time of 3 months or longer (2.23 months; 95% CI, 0.81-3.66 months) but not among patients with prior docetaxel (-0.25 months; 95% CI, -2.59 to 2.09 months) or with PSA doubling time of less than 3 months (0.05 months; 95% CI, -1.05 to 1.15 months).
UNASSIGNED: In this cohort study of patients with mCRPC, initiation of enzalutamide was associated with small but statistically significant improvements in OS, PCS, TTS, and TTR compared with initiation of abiraterone acetate. The improvements were more prominent in short-term outcomes, including TTS and TTR, and in patient subgroups without prior docetaxel or with PSA doubling time longer than 3 months.