The Clinical Efficacy Of Enzalutamide And Abiraterone In The Treatment Of Metastatic Castration-resistant Prostate Cancer

Objective:To compare the early clinical efficacy of enzalutamide combined with androgen deprivation therapy(ADT)and abiraterone acetate combined with androgen deprivation therapy(ADT)in the treatment of metastatic castration-resistant prostate cancer(m CRPC).Methods:Retrospective analysis of 68 patients with m CRPC in urology department of 3hospitals in this area from June 2018 to February 2021..According to the different drugs received,they were divided into two groups: Enzalumide group,a total of 32 cases,treated with Enzalumide +ADT;abiraterone group,a total of 36 cases,were treated with abiraterone acetate combined with prednisone +ADT 。 The general clinical data of two groups of patients were collected,including the lowest value of PSA after treatment,the disease-free survival time and the time from PSA to progression.The 3-month PSA response rate and 1-year disease-free survival rate were calculated,and the differences of clinical efficacy and safety between the two groups were analyzed and compared.Results:The average initial PSA of enzalutamide group and abiraterone group were104.95±15.34 ng/ml and 94.94±6.59 ng/ml respectively,and the average PSA of enzalutamide group was higher(P=0.001).The age,body mass index(BMI),ECOG score,tumor T stage,lymph node metastasis,bone metastasis,Gleason score,Pre-medication PSA,visceral metastasis and hypertension history were compared.There was no significant difference in diabetes history and other general clinical data.The median follow-up time was 13.4(12.0-14.7)months in the enzalutamide group and 12.1(6.4-14.4)months in the abiraterone group.The 1-year disease-free survival rates of enzalutamide group and abiraterone group were(62.5% and 47.2%,P=0.011),the 3-month PSA response rates of enzalutamide group and abiraterone group were(78.13% and 52.78%,P=0.029),The remarkable effect: PSA decreased by≥ 50%,which was 71.8% vs47.3% in enzalutamide group and abiraterone group,respectively,P=0.039.and the median progression-free survival rates of enzalutamide group and abiraterone group were(13.6 months and 10.1 months,P=0.005).The PSA decreased to the lowest value(0.05 ng/ml and 0.09ng/ml,P=0.016)in enzalutamide group and abiraterone group,respectively,and the PSA progressed in enzalutamide group and abiraterone group(12.8 months and 10.5 months,P=0.001).In terms of drug safety,the main adverse reactions of enzalutamide were 4 patients with fatigue(12.5%),3 patients with elevated blood sugar(9.38%),2 patients with hot flashes(6.25%),1 patient with back/joint pain(3.13%)and 1 patient with hypertension(3.13%).The main adverse reactions in abiraterone group were 4 patients with elevated liver transaminase(11.1%),3 patients with elevated blood sugar(8.3%),2patients with gastrointestinal reaction(5.6%),2 patients with hypertension(5.6%)and3 patients with hypokalemia(8.3%).The total adverse reaction rate of the two groups was 34.4% vs.38.9.There was no statistical difference.The adverse reactions of both groups can be treated symptomatically,without stopping the drug,and can be tolerated.Conclusion:In this study,compared with abiraterone combined with prednisone and ADT in the treatment of m CRPC,enzalutamide +ADT can improve the progression-free survival time of patients within one year,increase the response rate of PSA and prolong the time of PSA progression.The effect of reducing PSA to the lowest value is more obvirous,and the early curative effect is considerable.The adverse drug reactions of the two groups are few,the safety and tolerance are good,the early curative effect is considerable,and the long-term curative effect still needs to be studied and followed up.