Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA.
Drugs. 2013 Sep;73(13):1417-30. doi: 10.1007/s40265-013-0107-2.
Despite state of the art local therapy, a significant portion of men with high-risk prostate cancer develop progressive disease. Neoadjuvant systemic therapy prior to radical prostatectomy (RP) is an approach that can potentially maximize survival outcomes in patients with localized disease. This approach is under investigation with a wide array of agents and provides an opportunity to assess pathologic and biologic activity of novel treatments. The aim of this review is to explore the past and present role of neoadjuvant therapy prior to definitive therapy with RP in patients with high-risk localized or locally advanced disease. The results of neoadjuvant androgen-deprivation therapy (ADT), including use of newer agents such as abiraterone, are promising. Neoadjuvant chemotherapy, primarily with docetaxel, with or without ADT has also demonstrated efficacy in men with high-risk disease. Other novel agents targeting the vascular endothelial growth factor receptor (VEGFR), epidermal growth factor receptor (EGFR), platelet-derived growth factor receptor (PDGFR), clusterin, and the immune system are currently under investigation and have led to variable results in early clinical trials. Despite optimistic data, approval of neoadjuvant therapy prior to RP in patients with high-risk prostate cancer will depend on positive results from well designed phase III trials.
尽管采用了最先进的局部治疗方法，仍有相当一部分高危前列腺癌患者会出现疾病进展。在根治性前列腺切除术（RP）前进行新辅助系统治疗是一种可能最大限度提高局限性疾病患者生存结局的方法。这种方法正在广泛的药物治疗中进行研究，并为评估新型治疗方法的病理和生物学活性提供了机会。本综述旨在探讨新辅助治疗在高危局限性或局部进展性疾病患者中作为 RP 确定性治疗之前的过去和现在的作用。新辅助去势治疗（ADT）的结果，包括使用阿比特龙等新型药物，令人鼓舞。新辅助化疗，主要是多西他赛，联合或不联合 ADT，在高危疾病患者中也显示出疗效。其他针对血管内皮生长因子受体（VEGFR）、表皮生长因子受体（EGFR）、血小板衍生生长因子受体（PDGFR）、聚集素和免疫系统的新型药物目前正在研究中，并在早期临床试验中取得了不同的结果。尽管数据乐观，但新辅助治疗在高危前列腺癌患者中 RP 之前的应用的批准将取决于精心设计的 III 期试验的阳性结果。
