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持续的雄激素剥夺疗法与或没有转移导向的治疗为Oligometastatic前列腺癌:多中心的第二阶段随机扩展试验

Alexander D Sherry¹, Bilal A Siddiqui², Cara Haymaker³

¹Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, The Mayo Clinic, Rochester, MN, USA.

European urology

|August 1, 2025

概括

以转移为导向的疗法 (MDT) 与雄激素剥夺疗法 (ADT) 结合,显著改善了小卵性前列腺癌 (omPC) 患者的无进展生存期 (PFS). 这种组合疗法还增强了免疫反应,表明了未来免疫疗法的潜力.

科学领域:

在瘤学瘤学.
泌尿器科泌尿器科泌尿器科泌尿器科
免疫学免疫学免疫学

背景情况:

低基质前列腺癌 (omPC) 是由有限数量的转移而定义的.
目前对omPC的治疗模式通常涉及雄激素剥夺疗法 (ADT).

研究的目的:

评估转移导向疗法 (MDT) 加ADT与单独ADT相比在OMPC患者中的疗效.
研究MDT+ADT对临床结果和免疫反应的影响.

主要方法:

一个多中心的2期随机试验 (EXTEND),比较ADT与MDT+ADT.
患者被随机分为两个独立的篮子:间歇性ADT和连续性ADT.
主要终点是无进展生存 (PFS);次要终点包括放射性PFS (rPFS) 和无割抵抗生存 (CRFS).

主要成果:

与单独使用ADT相比,MDT + ADT在连续ADT篮子 (47个月与22个月) 和联合分析 (36个月与17个月) 中显著改善了PFS中位数.
通过MDT + ADT观察到优异的RPFS和CRFS.
持久的反应与系统性免疫激活增加有关,包括Th1-极化细胞因子上调和CD8+T细胞增殖.

结论:

MDT + ADT代表了对omPC的优越治疗策略,显著改善了PFS.
观察到的免疫激活表明,在未来的临床试验中,有可能将MDT与T细胞向免疫疗法结合起来.
这些发现的第三阶段确认是合理的.

关键词:

局部巩固性疗法局部巩固性治疗以转移为导向的疗法.有氧基质扩散症 (Oligometastasis)前列腺腺癌前列腺腺癌.立体性废除性辐射疗法是一种刻板的疗法.

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