［前列腺癌］达洛鲁胺治疗非转移性去势抵抗性前列腺癌

达洛鲁胺治疗非转移性去势抵抗性前列腺癌

Darolutamide for Nonmetastatic, Castration-Resistant Prostate Cancer

2020 年 9 月 10 日

朗读者： Dr. Stephen Morrissey, NEJM 执行主编

非转移性去势抵抗性前列腺癌患者有进展为转移性前列腺癌的风险，而转移性前列腺癌常会伴发与癌症相关的症状。在尽可能减少与治疗相关的不良事件的同时延长患者生存期，延缓症状发生时间是关键治疗目标。短视频中总结了新的研究发现。

NEJM 医学前沿

达洛鲁胺治疗非转移性去势抵抗性前列腺癌

小程序

非转移性去势抵抗性前列腺癌患者接受达洛鲁胺治疗后的生存期

Nonmetastatic, Castration-Resistant Prostate Cancer and Survival with Darolutamide

摘 要

背景

Darolutamide is a structurally distinct androgen-receptor inhibitor that is approved for the treatment of nonmetastatic, castration-resistant prostate cancer. In the planned primary analysis of a phase 3 trial, the median metastasis-free survival was significantly longer with darolutamide (40.4 months ) than with placebo (18.4 months ). The data for the analysis of overall survival were immature at the time of the primary analysis.

方法

In this double-blind, placebo-controlled trial, we randomly assigned 1509 men, in a 2: 1 ratio, to receive darolutamide (955 patients ) or placebo (554 patients ) while they continued to receive androgen-deprivation therapy. After the results of the primary end-point analysis were found to be positive, unblinding of the treatment assignments occurred, and patients in the placebo group were permitted to cross over to receive open-label darolutamide treatment. At the time of this prespecified final analysis, which had been planned to be performed after approximately 240 deaths had occurred, overall survival and all other secondary end points were evaluated.

结果

The median follow-up time was 29.0 months. At the time of unblinding of the data, all 170 patients who were still receiving placebo crossed over to receive darolutamide; 137 patients who had discontinued placebo before unblinding had occurred received at least one other life-prolonging therapy. Overall survival at 3 years was 83% (95% confidence interval [CI], 80 to 86 ) in the darolutamide group and 77% (95% CI, 72 to 81 ) in the placebo group. The risk of death was significantly lower, by 31%, in the darolutamide group than in the placebo group (hazard ratio for death, 0.69; 95% CI, 0.53 to 0.88; P=0.003 ). Darolutamide was also associated with a significant benefit with respect to all other secondary end points, including the time to first symptomatic skeletal event and the time to first use of cytotoxic chemotherapy. The incidence of adverse events after the start of treatment was similar in the two groups; no new safety signals were observed.

结论

Among men with nonmetastatic, castration-resistant prostate cancer, the percentage of patients who were alive at 3 years was significantly higher among those who received darolutamide than among those who received placebo. The incidence of adverse events was similar in the two groups. (Funded by Bayer HealthCare and Orion Pharma; ARAMIS ClinicalTrials.gov number, NCT02200614.)

Karim Fizazi, Neal Shore, Teuvo L. Tammela, et al. Nonmetastatic, Castration-Resistant Prostate Cancer and Survival with Darolutamide. DOI: 10.1056/NEJMoa2001342