多西他赛联合卡铂治疗转移性去势抵抗性前列腺癌的临床疗效

doi:10.19723/j.issn.1671-167X.2021.04.011

摘要/Abstract

摘要：

目的: 评估转移性去势抵抗性前列腺癌(metastatic castration-resistant prostate cancer, mCRPC)患者进行多西他赛联合卡铂治疗的近期疗效和安全性。方法: 选取 2017年5月至2019年7月在北京大学第一医院治疗的15例mCRPC患者为研究对象,中位年龄70岁(43~77岁),病理类型均为前列腺腺癌,影像学证实为全身转移,采用多西他赛联合卡铂的化疗方案,观察化疗4周期后前列腺特异性抗原(prostate-specific antigen, PSA)下降幅度、疼痛缓解率及不良反应发生情况,并进行数据分析。结果: 15例患者中,12例至少完成4个周期化疗并进行近期疗效评价,其中8例 PSA下降幅度>50%,有效率为66.7%;9例伴有骨痛的患者,疼痛数字评分法(numerical rating scales, NRS)平均分从4.7分下降至2.4分,有4例骨痛明显缓解,癌痛缓解率为44.4%;具有可测量转移病灶的4例患者中,达到部分缓解2例,疾病稳定1例,疾病进展1例;化疗的主要不良反应包括骨髓抑制、胃肠道反应、乏力、神经障碍等,大部分患者均在可耐受的范围。结论: 多西他赛联合卡铂治疗mCRPC具有良好的近期疗效,治疗过程中严重不良反应发生率较低,安全性较高,值得在临床上进一步推广和探索。

关键词: 多西他赛, 卡铂, 前列腺癌

Abstract:

Objective: To observe the early efficacy and toxicity of docetaxel combined with carboplatin in patients with metastatic castration-resistant prostate cancer (mCRPC). Methods: From May 2017 to July 2019, fifteen patients with mCRPC treated in Peking University First Hospital were collected. The median age was 70 years (43-77 years), and the pathological types were all adenocarcinoma, which was confirmed as distant metastasis by imaging examination. They were given the chemotherapy of docetaxel combined with carboplatin. The specific method was as follows: each cycle was 28 days. Androgen deprivation therapy was administered routinely throughout the treatment period. Blood routine, liver and kidney function, blood clotting function and prostate-specific antigen (PSA) tests were performed before each cycle. Docetaxel was administered intravenously on the first day of each cycle at a dose of 75 mg/m², and carboplatin was administered intravenously on the second day at the dose calculated by Calvert formula. The main outcome measures including PSA decline range, pain remission rate and occurrence of adverse reactions were observed and analyzed. Results: Among the 15 patients, 12 had completed at least 4 cycles of chemotherapy and had short-term efficacy evaluation. PSA decline range>50% was observed in 8 patients (66.7%). Among the 9 patients with bone pain, remarkable pain relief was observed in 4 patients (44.4%). Among the 4 patients with measurable metastatic lesions, 2 achieved partial response, 1 was evaluated as stable disease, and 1 was evaluated as progressive disease. The main adverse reactions of chemotherapy included bone marrow suppression, gastrointestinal reactions, fatigue and neurological disorders, and most of them were within the tolerable range. Conclusion: This report is a case series study of docetaxel combined with carboplatin in the treatment of mCRPC reported in China and the conclusions are representative. The chemotherapy of docetaxel combined with carboplatin has positive short-term efficacy and high safety in patients with mCRPC, which is worthy of further promotion and exploration in clinical practice.

Key words: Docetaxel, Carboplatin, Prostate cancer

中图分类号:

R697+.3

白杲琛,宋毅,金杰,虞巍,何志嵩. 多西他赛联合卡铂治疗转移性去势抵抗性前列腺癌的临床疗效[J]. 北京大学学报（医学版）, 2021, 53(4): 686-691.

BAI Gao-chen,SONG Yi,JIN Jie,YU Wei,HE Zhi-song. Clinical efficacy of docetaxel combined with carboplatin in patients with metastatic castration-resistant prostate cancer[J]. Journal of Peking University (Health Sciences), 2021, 53(4): 686-691.

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Characteristics	n
Age/years
≤70	8
>70	7
Primary tumor (T stage)
T1-T2	2
T3-T4	13
Regional lymph node (N stage)
N0	1
N1	14
Distant metastasis (M stage)
M0	0
M1a	1
M1b	13
M1c	1
Gleason score
≤8	7
>8	8
PSA level before treatment/(mg/L)
≤20	5
>20	10
NRS for bone pain/(point)
No pain (0)	3
Mild pain (1-3)	1
Moderate pain (4-6)	7
Severe pain (7-10)	4
Treatment phase for mCRPC
First-line	4
Second-line	7
Third-line	4
Fourth-line or more	0

Items	n (%)
PSA decline in 12 evaluable patients
>50%	8(66.6)
0%-50%	1(8.3)
<0%	3(25.0)
Pain response in 9 patients with ostalgia
Decreased	4(44.4)
Stable	4(44.4)
Increased	1(11.1)
RECIST assessment in 4 patients with measurable metastatic lesions
Complete response	0(0)
Partial response	2(50.0)
Stable disease	1(25.0)
Progressive disease	1(25.0)

Adverse reactions	Total	Grade 1	Grade 2	Grade 3	Grade 4
Leukopenia	6(40.0)	4(26.7)	2(13.3)	0(0)	0(0)
Anemia	6(40.0)	2(13.3)	2(13.3)	2(13.3)	0(0)
Thrombocytopenia	1(6.7)	1(6.7)	0(0)	0(0)	0(0)
Liver function damage	1(6.7)	1(6.7)	0(0)	0(0)	0(0)
Gastrointestinal hemorrhage	1(6.7)	0(0)	1(6.7)	0(0)	0(0)
Nausea/vomiting	3(20.0)	2(13.3)	1(6.7)	0(0)	0(0)
Diarrhea	1(6.7)	1(6.7)	0(0)	0(0)	0(0)
Constipation	1(6.7)	1(6.7)	0(0)	0(0)	0(0)
Fatigue	2(13.3)	1(6.7)	1(6.7)	0(0)	0(0)
Neurological disorders	2(13.3)	2(13.3)	0(0)	0(0)	0(0)
Pigmentation	1(6.7)	1(6.7)	1(6.7)	0(0)	0(0)
Severe infections	1(6.7)	0(0)	0(0)	0(0)	1(6.7)