近日，英国癌症研究所和皇家马斯登医院Johann de Bono课题组探讨了奥拉帕尼治疗转移性去势耐药前列腺癌的疗效。相关论文于2020年4月28日发表在《新英格兰医学杂志》上。
Title: Olaparib for Metastatic Castration-Resistant Prostate Cancer
Author: Johann de Bono, M.B., Ch.B., Ph.D.,, Joaquin Mateo, M.D., Ph.D.,, Karim Fizazi, M.D., Ph.D.,, Fred Saad, M.D.,, Neal Shore, M.D.,, Shahneen Sandhu, M.D.,, Kim N. Chi, M.D.,, Oliver Sartor, M.D.,, Neeraj Agarwal, M.D.,, David Olmos, M.D., Ph.D.,, Antoine Thiery-Vuillemin, M.D., Ph.D.,, Przemyslaw Twardowski, M.D.,, Niven Mehra, M.D., Ph.D.,, Carsten Goessl, M.D.,, Jinyu Kang, M.D.,, Joseph Burgents, Ph.D.,, Wenting Wu, Ph.D.,, Alexander Kohlmann, Ph.D.,, Carrie A. Adelman, Ph.D.,, and Maha Hussain, M.B., Ch.B.
Multiple loss-of-function alterations in genes that are involved in DNA repair, including homologous recombination repair, are associated with response to poly(adenosine diphosphate–ribose) polymerase (PARP) inhibition in patients with prostate and other cancers.
We conducted a randomized, open-label, phase 3 trial evaluating the PARP inhibitor olaparib in men with metastatic castration-resistant prostate cancer who had disease progression while receiving a new hormonal agent (e.g., enzalutamide or abiraterone). All the men had a qualifying alteration in prespecified genes with a direct or indirect role in homologous recombination repair. Cohort A (245 patients) had at least one alteration in BRCA1, BRCA2, or ATM; cohort B (142 patients) had alterations in any of 12 other prespecified genes, prospectively and centrally determined from tumor tissue. Patients were randomly assigned (in a 2:1 ratio) to receive olaparib or the physician’s choice of enzalutamide or abiraterone (control). The primary end point was imaging-based progression-free survival in cohort A according to blinded independent central review.
In cohort A, imaging-based progression-free survival was significantly longer in the olaparib group than in the control group (median, 7.4 months vs. 3.6 months; hazard ratio for progression or death, 0.34; 95% confidence interval, 0.25 to 0.47; P<0.001); a significant benefit was also observed with respect to the confirmed objective response rate and the time to pain progression. The median overall survival in cohort A was 18.5 months in the olaparib group and 15.1 months in the control group; 81% of the patients in the control group who had progression crossed over to receive olaparib. A significant benefit for olaparib was also seen for imaging-based progression-free survival in the overall population (cohorts A and B). Anemia and nausea were the main toxic effects in patients who received olaparib.
In men with metastatic castration-resistant prostate cancer who had disease progression while receiving enzalutamide or abiraterone and who had alterations in genes with a role in homologous recombination repair, olaparib was associated with longer progression-free survival and better measures of response and patient-reported end points than either enzalutamide or abiraterone.