Bristol Haematology and Oncology Centre, Bristol, UK.
BJU Int. 2012 Oct;110(8):1110-4. doi: 10.1111/j.1464-410X.2012.11076.x. Epub 2012 May 7.
What's known on the subject? and What does the study add? Metastatic castrate-resistant prostate cancer (mCRPC) was historically considered to be an aggressive disease resistant to conventional anticancer therapy. Within the last decade the outlook has changed beyond recognition; docetaxel chemotherapy is now firmly established as a well-tolerated treatment with significant survival benefits. Building on this, more recently there have been several landmark developments using various approaches in patients whose disease has progressed despite previous chemotherapy. Cabazitaxel chemotherapy offers survival and health-related quality of life (HRQL) improvements in this setting, as does the CYP inhibitor abiraterone acetate. Significant clinical benefits are also seen with novel radioisotope and immunotherapeutic approaches. There have been many developments in the management of this condition within the last 2 years, with several landmark studies showing new treatments that offer survival and HRQL benefits even in the setting of advanced disease, which has been heavily pretreated. This review article summarises these important developments and gives the reader an overview of current practice, recent changes and future directions. With current and forthcoming developments in the treatment of metastatic castrate-resistant prostate cancer (mCRPC) post-docetaxel, we are embarking on an age of potential 'chronic' management of this disease. It is hoped that the survival benefits associated with the various treatments, cytotoxic, hormonal and immunotherapeutic, will prove to be additive, providing a multimodal continuum of care. If so, it will be necessary to determine the optimal sequence and timing of the new treatments. One key factor in this regard is likely to be the patient's performance status and hence his eligibility for cytotoxic intervention. If chemotherapy is offered early in the post-docetaxel pathway, the patient may still be able to benefit from non-chemotherapeutic options subsequently. However, if this stage of management begins with a non-chemotherapeutic option, there is a risk that the patient's performance status will decline before he has an opportunity to benefit from chemotherapy. Further studies and ongoing clinical experience are likely to clarify this important issue, and help clinicians to maximise the survival of men with mCRPC post-docetaxel.
转移性去势抵抗性前列腺癌（mCRPC）在过去被认为是一种对常规抗癌治疗具有抗药性的侵袭性疾病。在过去的十年中，情况发生了翻天覆地的变化；多西紫杉醇化疗现已成为一种耐受良好的治疗方法，具有显著的生存获益。在此基础上，最近在那些尽管之前接受过化疗但疾病仍在进展的患者中，采用了多种方法取得了几项里程碑式的进展。卡巴他赛化疗在这种情况下可提高生存率和健康相关生活质量（HRQL），CYP 抑制剂阿比特龙也有此作用。新型放射性同位素和免疫治疗方法也取得了显著的临床获益。在过去的 2 年中，这种疾病的治疗方法有了许多进展，多项里程碑式的研究表明，即使在经过大量预处理的晚期疾病中，新的治疗方法也能提供生存和 HRQL 获益。本文综述了这些重要进展，并为读者概述了当前的实践、最近的变化和未来的方向。随着转移性去势抵抗性前列腺癌（mCRPC）多西紫杉醇治疗后的最新进展，我们正在进入这种疾病潜在“慢性”管理的时代。人们希望各种治疗方法（细胞毒性、激素和免疫治疗）带来的生存获益是累加的，从而提供一种多模式的连续护理。如果是这样，就有必要确定新治疗方法的最佳顺序和时机。在这方面的一个关键因素可能是患者的体能状态，从而决定了他是否有资格接受细胞毒性干预。如果在多西紫杉醇治疗后尽早进行化疗，患者随后仍有可能受益于非化疗选择。然而，如果管理的这一阶段从非化疗选择开始，那么患者的体能状态在有机会接受化疗之前下降的风险就会增加。进一步的研究和正在进行的临床经验可能会阐明这个重要问题，并帮助临床医生最大限度地提高多西紫杉醇治疗后 mCRPC 患者的生存率。
