期刊
CLINICAL CANCER RESEARCH
卷 28, 期 5, 页码 860-869出版社
AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1078-0432.CCR-21-1090
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资金
- Conquer Cancer Foundation of the American Society of Clinical Oncology Jonathan Nebel Young Investigator Award
- Prostate Cancer Foundation Young Investigator Award [20YOUN22]
- K12 Paul Calabresi Career Development Award for Clinical Oncology [K12CA184746]
- Pfizer Inc.
- Astellas Pharma, Inc.
- NIH SPORE grant [P50-CA92629]
- Cancer support grant [P30 CA008748]
This study found that concurrent corticosteroid use (CCU) in enzalutamide-treated patients with metastatic castration-resistant prostate cancer (mCRPC) was associated with worse clinical outcomes. However, enzalutamide treatment still improved overall survival, radiographic progression-free survival, and time to prostate-specific antigen progression in these patients.
Purpose: The clinical impact of concurrent corticosteroid use (CCU) on enzalutamide-treated patients with metastatic castration resistant prostate cancer (mCRPC) is unknown. We investigated the association of CCU with overall survival (OS), radiographic progression-free survival (rPFS), and time to prostate-specific antigen progression (TTPP) in post-chemotherapy, enzalutamide-treated patients with mCRPC. Patients and Methods: Post hoc analysis of AFFIRM (NCT00974311) with patients (n = 1,199) randomized 2:1 to enzalutamide 160 mg/day or placebo. Treatment group, CCU, and known prognostic factors were evaluated for impact on OS, rPFS, and TTPP using a multivariate Cox proportional hazards model. CCU was defined as baseline (use started at baseline) or on-study (baseline plus use that was started during the trial). Results: Enzalutamide significantly improved OS, rPFS, and TTPP independent of baseline CCU but was associated with inferior clinical outcomes when compared with no baseline CCU, including a shorter OS [10.8 months vs. not reached (NR); HR for use vs. no use, 2.13; 95% confidence interval (CI), 1.79-2.54], rPFS (5.2 months vs. 8.0 months; HR, 1.49; 95% CI, 1.29-1.72], and TTPP (4.6 months vs. 5.7 months; HR, 1.50; 95% CI, 1.25-1.81). These findings held in a multivariate analysis adjusting for baseline prognostic factors wherein baseline CCU was independently associated with decreased OS (HR, 1.71; 95% CI, 1.43-2.04; P < 0.0001) and rPFS (HR, 1.28; 95% CI, 1.11-1.48; P = 0.0007). Conclusions: Patients with mCRPC benefited from enzalutamide treatment independent of CCU, but CCU was associated with worse baseline prognostic factors and outcomes.
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