Efficacy Analysis Of Enzalutamide,abiraterone And Bicalutamide In The Treatment Of Metastatic Prostate Cancer

Objectives: A number of phase III clinical trials have verified that enzalutamide and abiraterone are effective treatments for metastatic prostate cancer(m PCa),but which drug has better efficacy and safety is not clear.This study aimed to evaluate whether enzalutamide,abiraterone,and bicalutamide differ in efficacy and safety in the treatment of m PCa,and to provide real-world research data for clinicians to use drugs rationally.Methods: A total of 190 m PCa patients who were diagnosed and treated with enzalutamide,abiraterone or bicalutamide in the Second Hospital of Lanzhou University,People’s Hospital of Gansu Provincial and Cancer Hospital of Gansu Provincial from January 2018 to March 2023 were enrolled.According to the different stages of the disease,it is divided into metastatic hormone-sensitive prostate cancer(mHSPC)and metastatic castration-resistant prostate cancer(mCRPC).According to the different of drugs,it is divided into enzalutamide group,abiraterone group and bicalutamide group.The clinical data and follow-up data of the patients were collected.The median progression-free survival(PFS),prostate specific antigen(PSA)response and imaging response were observed to compare the therapeutic effect and treatmentrelated adverse events between mHSPC and mCRPC patients.Results: A total of 190 patients were included in this study,including 127 patients in the mHSPC group and 63 patients in the mCRPC group.Among mHSPC patients,there are 34 patients in enzalutamide group,47 patients in abiraterone group and 46 patients in bicalutamide group.Compared with bicalutamide,new endocrine drugs(enzalutamide and abiraterone)can significantly prolong the median PFS of mHSPC patients(enzalutamide group not reached,abiraterone group 24 months,bicalutamide group 15 months;P<0.001),and enzalutamide was more effective than abiraterone(P=0.020).Multivariate COX regression analysis showed that enzalutamide treatment,PSA<100ng/m L and ECOG score 0-1 were favorable prognostic factors for prolonged median PFS in mHSPC patients.Chi-square analysis showed that new endocrine drugs were superior to bicalutamide in the PSA response and imaging improvement of mHSPC,and enzalutamide was more effective than abiraterone.Subgroup analysis showed that the observed indicators in different subgroups showed a consistent trend with the overall results.mHSPC patients with high tumor burden and Gleason≥8 had better PSA response and imaging improvement with enzalutamide.The incidence of all grade adverse events and Grade≥3 adverse events was similar among the three drugs,and the results were not statistically significant(P=0.366;P=0.830).Among mCRPC patients,there are 32 patients in enzalutamide group and 31 patients in abiraterone group.Enzalutamide showed a trend to prolong the median PFS of mCRPC patients compared with abiraterone(18 months in the enzalutamide group and 13 months in the abiraterone group),but the difference was not statistically significant(P=0.113).Multivariate COX regression analysis showed that enzalutamide treatment,tumor stage T2/T3 and ECOG score 0-1 were favorable prognostic factors for prolonged PFS in mCRPC patients.Chi-square analysis showed that enzalutamide could reduce the PSA level of mCRPC patients to nadir PSA(n PSA)faster than abiraterone(P=0.031).Subgroup analysis showed that the observed indicators in different subgroups showed a consistent trend with the overall results,and the PSA response of T4 stage patients and Gleason≥8 patients with enzalutamide was more significant.There was no significant difference in the incidence of adverse events and Grade≥3 adverse events between enzalutamide and abiraterone(P=0.514 and P=0.459).Conclusions: Compared with bicalutamide,the novel endocrine therapy can significantly prolong the median PFS of mHSPC patients,with better PSA response and imaging improvement,especially for patients with high tumor burden and Gleason≥8,and enzalutamide is more effective.For mCRPC patients,enzalutamide showed a trend to prolong the median PFS compared with abiraterone,but the difference was not statistically significant.Enzalutamide can significantly improve PSA response in mCRPC patients,especially for patients with T4 stage or Gleason≥8.The new endocrine drugs are well tolerated,and there is no statistically significant difference in the incidence of adverse events and serious adverse events compared with traditional drugs in the treatment of m PCa patients,which has high safety and is worthy of promotion.