三线治疗和 Lu-PSMA 放射性配体疗法治疗转移性去势抵抗性前列腺癌：系统评价。
Third-line treatment and Lu-PSMA radioligand therapy of metastatic castration-resistant prostate cancer: a systematic review.
机构信息
Center of Tobacco Control Research, Birkevej 17, DK 5230, Odense M, Denmark.
Department of Oncology, Medical Oncology Unit, San Donato Hospital, Arezzo, Italy.
出版信息
Eur J Nucl Med Mol Imaging. 2018 Mar;45(3):496-508. doi: 10.1007/s00259-017-3895-x. Epub 2017 Dec 16.
AIMS
There is a controversy as to the relative efficacy of Lu prostate specific membrane antigen (PSMA) radioligand therapy (RLT) and third-line treatment for patients with metastatic castration-resistant prostate cancer (mCRPC). The aim of our systematic review was to elucidate whether Lu-PSMA RLT and third-line treatment have similar effects and adverse effects (PROSPERO ID CRD42017067743).
METHODS
The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches in Pubmed and Embase selected articles up to September 2017. A search in ClinicalTrials.gov indicated ongoing studies. The meta-analysis used the random-effects model.
RESULTS
Twelve studies including 669 patients reported Lu-PSMA RLT. Overall, 43% of the patients had a maximum decline of PSA of ≥50% following treatment with Lu-PSMA RLT. The treatment with Lu-PSMA-617 and Lu-PSMA for imaging and therapy (I&T) had mainly transient adverse effects. Sixteen studies including 1338 patients reported third-line treatment. Overall, 21% of the patients had a best decline of PSA of ≥50% following third-line treatment. After third-line treatment with enzalutamide and cabazitaxel, adverse effects caused discontinuation of treatment for 10% to 23% of the patients. Lu-PSMA RLT gave a best PSA decline ≥50% more often than third-line treatment (mean 44% versus 22%, p = 0.0002, t test). Lu-PSMA RLT gave objective remission more often than third-line treatment (overall 31 of 109 patients versus 43 of 275 patients, p = 0.004, χ test). Median survival was longer after Lu-PSMA RLT than after third-line treatment, but the difference was not statistically significant (mean 14 months versus 12 months, p = 0.32, t test). Adverse effects caused discontinuation of treatment more often for third-line treatment than for Lu-PSMA RLT (22 of 66 patients versus 0 of 469 patients, p < 0.001, χ test).
CONCLUSIONS
As for patients with mCRPC, treatment with Lu-PSMA-617 RTL and Lu-PSMA I&T gave better effects and caused fewer adverse effects than third-line treatment.
目的
Lu 前列腺特异性膜抗原（PSMA）放射性配体治疗（RLT）与转移性去势抵抗性前列腺癌（mCRPC）的三线治疗相比，其相对疗效存在争议。本系统评价的目的是阐明 Lu-PSMA RLT 和三线治疗是否具有相似的疗效和不良反应。（PROSPERO ID CRD42017067743）
方法
本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。在 Pubmed 和 Embase 中进行检索，检索时间截至 2017 年 9 月。在 ClinicalTrials.gov 中进行检索，以确定正在进行的研究。荟萃分析采用随机效应模型。
结果
12 项研究共纳入 669 例患者，报告了 Lu-PSMA RLT 的结果。总体而言，43%的患者在接受 Lu-PSMA RLT 治疗后 PSA 最大下降≥50%。Lu-PSMA-617 和 Lu-PSMA 用于成像和治疗（I&T）的治疗主要有短暂的不良反应。16 项研究共纳入 1338 例患者，报告了三线治疗的结果。总体而言，21%的患者在三线治疗后 PSA 最佳下降≥50%。接受恩扎鲁胺和卡巴他赛三线治疗后，10%至 23%的患者因不良反应而停止治疗。Lu-PSMA RLT 使 PSA 下降≥50%的最佳疗效比三线治疗更常见（平均 44%对 22%，p=0.0002，t 检验）。Lu-PSMA RLT 比三线治疗更能获得客观缓解（总体 109 例患者中有 31 例，275 例患者中有 43 例，p=0.004，卡方检验）。Lu-PSMA RLT 后中位生存时间长于三线治疗，但差异无统计学意义（平均 14 个月对 12 个月，p=0.32，t 检验）。三线治疗因不良反应而停药的发生率高于 Lu-PSMA RLT（66 例患者中有 22 例，469 例患者中有 0 例，p<0.001，卡方检验）。
结论
对于 mCRPC 患者，Lu-PSMA-617 RTL 和 Lu-PSMA I&T 治疗的效果优于三线治疗，且不良反应较少。
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