演題抄録

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開催概要
開催回
第56回・2018年・横浜
 

CRPCに対するエンザルタミド治療早期、増悪時のPSA動態に着目した予後予測因子の検討

演題番号 : P43-4

[筆頭演者]
演者)宮澤 慶行:1 
[共同演者]
清水 信明:2、竹澤 豊:3、中村 敏之:4、宮尾 武士:1、蓮見 勝:2、悦永 徹:3、奥木 宏延:4、村松 和道:2、牧野 武朗:3、岡崎 浩:4、関根 芳岳:1、小池 秀和:1、松井 博:1、鈴木 和浩:1

1:群馬大学・泌尿器科、2:群馬県立がんセンター・泌尿器科、3:伊勢崎市民病院・泌尿器科、4:館林厚生病院・泌尿器科

 

Background: Recent studies have shown that an early PSA response to AR-targeting agents in mCRPC is associated with a better prognosis. We analyzed the early PSA response to enzalutamide (ENZ) by measuring the PSA doubling time (PSADT) and PSA Velocity (PSAV) while monitoring oncologic outcomes and survival in Japanese patients.
Patients and Methods: A total of 241 patients with mCRPC treated with ENZ were analysed. Patients' median age is 75±7.9 (range 53-93). The PSA-PFS and OS were assessed according to PCWG2 criteria. This study was approved by the institutional review board of Gunma University Hospital (No.1595).
Results: A case where PSA did not decline at all was defined as Primary Resistance (PR). A case in which PSA once declined after treatment but then progressed was defined as Acquired Resistance (AR). Those in which PSA remained low after treatment were defined as Good Response (GR). We observed 77 PR cases (31.9 %), 125 AR cases (51.9 %) and 39 GR cases (16.2 %).PSA-PFS and OS pre-docetaxel were significantly increased as compared to patients' post-docetaxcel (PSA-PFS; 47.0 wks vs. 13.4 wks p<0.001, OS; Not Yet Reached vs. 80.7 wks p<0.001). Multivariate analysis of prognostic factors, including the PSA response at 4 weeks, was performed using a Cox regression analysis. The PS (0 or 1-2), Hb (≧11.4 or <11.4), time to CRPC(≧12 m or <12 m), docetaxel treatment history (none or done) and a PSA decrease of 50% at 4 weeks were all significant factors for the prediction of OS (all variables, p <0.05). In cases of acquired resistance (n=125), a multivariate analysis using PSA kinetics factors such as PSADT and PSAV at PSA progression, Hb, time to CRPC(≧12 m or <12 m), PSADT (≧2 months or <2 months) and PSAV (<20 ng/mL/month or≧20 ng/mL/month), were all factors predicting OS following PSA progression (p<0.05).
Conclusions: Our study has demonstrated that PSA dynamics after ENZ administration may be a useful prognostic factor for mCRPC patients.

キーワード

臓器別:前立腺・男性生殖器

手法別:内分泌・ホルモン療法

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