British Columbia Cancer Agency, Center for the Southern Interior, University of British Columbia, British Columbia, Canada.
Curr Opin Support Palliat Care. 2013 Sep;7(3):258-64. doi: 10.1097/SPC.0b013e328363602e.
To review the current status of intermittent androgen suppression in the management of biochemically recurrent or newly diagnosed metastatic prostate cancer with respect to two recently reported multicenter phase III randomized trials.
The Canadian lead trial for men with biochemically recurrent prostate cancer after definitive radiotherapy (National Cancer Institute of Canada Clinical Trials Group PR7) randomized 1386 men and found a hazard ratio for death of 1.03 at a median follow-up of 6.9 years, declaring intermittent therapy noninferior to continuous for the trial algorithm. Over the same time frame, the South West Oncology Group (SWOG) compared continuous to intermittent therapy in metastatic prostate cancer. Although results were very similar in absolute terms, at 9.8 years follow-up, the hazard ratio for death was 1.1 in favor of the continuous approach. Intermittent therapy could not be declared noninferior. Both trials reported improved quality of life in the intermittent arms.
There is a small increased risk for death from prostate cancer with the use of intermittent androgen suppression in both these patient populations. This situation may be especially true for higher Gleason score tumors (8-10) and in men with symptomatic bone metastases. Quality-of-life benefits may make this approach worthwhile for some individuals.
针对最近报道的两项多中心 III 期随机试验，就生化复发或新诊断转移性前列腺癌间歇性雄激素抑制治疗的现状进行综述。
加拿大前列腺癌根治性放疗后生化复发（加拿大国家癌症研究所临床试验组 PR7）的主导试验对 1386 例男性进行了随机分组，中位随访 6.9 年后发现死亡风险比为 1.03，表明在试验算法中，间歇性治疗与连续性治疗等效。在同一时间框架内，西南肿瘤协作组（SWOG）比较了转移性前列腺癌的连续性与间歇性治疗。尽管从绝对值来看结果非常相似，但在 9.8 年的随访中，死亡风险比有利于连续性治疗为 1.1。间歇性治疗不能被宣布为等效。这两项试验均报告间歇性治疗组的生活质量得到改善。
在这两个患者群体中，使用间歇性雄激素抑制治疗会导致前列腺癌死亡的风险略有增加。对于高 Gleason 评分（8-10）肿瘤和有症状骨转移的男性，这种情况可能更为明显。生活质量获益可能使这种方法对某些人有价值。
