Odrázka K, Vanásek J, Vaculíková M, Stejskal J, Filip S
Department of Oncology and Radiotherapy, Charles University Hospital, Hradec Králové, Czech Republic.
Neoplasma. 2000;47(4):197-203.
Hormonal therapy in disseminated prostate cancer is effective in 70-80% of patients and prolongs their lives of a mean 1-2 years. Sooner or later, androgen independence develops due to a multifactorial mechanism. A smaller part of patients may respond to second-line hormonal manipulations (antiandrogen withdrawal, adrenal enzymes synthesis inhibitors, corticosteroids). In hormone-refractory disease only about 30% of patients would respond to chemotherapy. In the standard chemotherapy the mostly used cytotoxic agents are anthracyclines, platinum derivatives, vinca alkaloids and cyclophosphamide. However, combined chemotherapy is not more effective than monotherapy. Conventional chemotherapy may improve especially the quality of life. The median survival in chemotherapy patients (6-12 months) is not significantly longer when compared with the best supportive care. In recent years the main concern has been focused on new cytotoxic drugs and different combinations with hormonal agents. In Phase II studies the combinations of estramustine with oral etoposide, estramustine with taxanes and alternating weekly regimens (doxorubicin, ketoconazole/estramustine, vinblastine) show higher response rates (53-69% of patients with prostate-specific antigen decline of more than 50%) and longer survival (13-19 months) than conventional chemotherapy.
激素疗法对转移性前列腺癌患者的有效率为70%-80%，可使患者平均寿命延长1-2年。由于多因素机制，迟早会出现雄激素非依赖性。一小部分患者可能对二线激素治疗（抗雄激素撤药、肾上腺酶合成抑制剂、皮质类固醇）有反应。在激素难治性疾病中，只有约30%的患者对化疗有反应。在标准化疗中，最常用的细胞毒性药物是蒽环类、铂类衍生物、长春花生物碱和环磷酰胺。然而，联合化疗并不比单一疗法更有效。传统化疗尤其可以改善生活质量。与最佳支持治疗相比，化疗患者的中位生存期（6-12个月）并没有显著延长。近年来，主要关注点集中在新的细胞毒性药物以及与激素药物的不同联合方案上。在II期研究中，雌莫司汀与口服依托泊苷联合、雌莫司汀与紫杉烷联合以及每周交替方案（多柔比星、酮康唑/雌莫司汀、长春碱）显示出比传统化疗更高的缓解率（53%-69%的患者前列腺特异性抗原下降超过50%）和更长的生存期（13-19个月）。
