Long‐Term Follow‐Up of Patients Treated with Intermittent Hormone Therapy for Advanced Prostate Cancer

G. Hruby, H. Gurney, S. Turner, M. Berry, P. Harnett, V. Gebski
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引用次数: 2

Abstract

Background: To determine the feasibility of long-term use of intermittent hormone therapy (IHT) in patients with advanced prostate cancer. Methods: Sixteen hormone-naive patients were commenced on IHT and prospectively reviewed. IHT consisted of goserelin acetate alone (two patients) or combined with an antiandrogen. When the serum prostate specific antigen (PSA) level had fallen to 10 ng/ml, the same treatment was recommenced, constituting one complete cycle comprising both “on-treatment” and “off-treatment” phases. This was repeated until hormone independence (HI) occurred. Results: The median length follow-up was 49.9 months. Considering all patients, a mean of 41% of the total time was spent off hormone treatment, ranging from a median of 4.0 to 7.1 months for each cycle. Fifteen patients finished at least one complete cycle of IHT, and 7 patients completed two or more cycles. Nine patients became HI after a mean time period of 19.5 months. Six men remain on IHT; three are currently in their fourth or fifth cycle of treatment. For patients completing Cycles 1, 2, 3, 4, and 5, the median percentage time spent off treatment during each cycle was 41%, 54%, 58%, 53%, and 58%, respectively. Conclusions: Based on this pilot study, IHT would seem to allow considerable time off therapy without obviously affecting the time to HI. If the current randomized trials of IHT against continuous therapy demonstrate equivalent relapse-free survival, then quality of life and fiscal end points will be paramount in determining treatment options. An Australian intergroup study to examine these end points has already begun.
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晚期前列腺癌间歇激素治疗患者的长期随访
背景:确定晚期前列腺癌患者长期使用间歇激素治疗(IHT)的可行性。方法:对16例激素初治患者进行IHT治疗并进行前瞻性回顾。IHT包括单独使用醋酸戈舍林(2例)或联合使用抗雄激素。当血清前列腺特异性抗原(PSA)水平降至10 ng/ml时,重新开始相同的治疗,构成一个完整的周期,包括“治疗”和“停止治疗”阶段。这是重复的,直到激素独立(HI)发生。结果:中位随访时间为49.9个月。考虑到所有患者,平均41%的总时间用于激素治疗,每个周期的中位数为4.0至7.1个月。15例患者完成了至少一个完整的IHT周期,7例患者完成了两个或更多周期。9名患者在平均19.5个月后成为HI。六名男子留在IHT;其中三人目前正处于第四或第五个治疗周期。对于完成第1、2、3、4和5个周期的患者,每个周期中停止治疗的中位数百分比分别为41%、54%、58%、53%和58%。结论:根据这项初步研究,IHT似乎允许相当长的治疗时间,而不会明显影响到HI的时间。如果目前IHT与持续治疗的随机试验显示出相同的无复发生存率,那么生活质量和财政终点将是决定治疗方案的最重要因素。一项针对这些终点的澳大利亚跨群体研究已经开始。
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