Basset V, Flamand V, Crouzet S, Ploussard G
Service d'urologie, CHU Saint-Louis, 1 av Claude-Vellefaux, 75010 Paris, France.
Prog Urol. 2013 Oct;23 Suppl 1:S44-8. doi: 10.1016/S1166-7087(13)70045-9.
Docetaxel has been the cornerstone in the treatment of castration- resistant prostate cancer (CRPC) since 2004. The recent and almost simultaneous arrival of new and effective molecules - several of which are already available on the market - has added to the CRPC treatment arsenal. Several studies have explored the optimal order in which these new treatments should be administered. The aim of this review was to present their respective predictive and evaluative factors and suggest potential administration sequences.
The PubMed medical literature citations database was searched using the following key words: prostate cancer, castration resistant, metastatic, targeted therapy, treatment sequence, immunotherapy and clinical trials. The reports of the most recent European and North American congresses were also included.
While no predictive factors have been clearly identified for these new therapies to date, a Gleason score of not less than 8 and one or more chemotherapy sessions seemed to be predictive of lower efficacy for abiraterone. Promising elements for further investigation include the circulating tumour cell count and variation in this count per treatment, ERG mutation status or the intratumoural androgen status. Substitution criteria have not yet been reported but, as is the case with all hormone therapies, changes in PSA levels emerge as a valuable indicator of the efficacy of abiraterone. The best treatment sequence for patients who develop castration-resistance remains to be defined.
Although new molecules have recently become available, the experience with their use is limited. Thus, no predictive markers of response rates and treatment outcomes or data concerning the best treatment sequence to use in patients with CRPC are as yet available.
自2004年以来，多西他赛一直是去势抵抗性前列腺癌（CRPC）治疗的基石。近期几种新的有效分子几乎同时出现——其中几种已上市——这增加了CRPC的治疗手段。多项研究探讨了这些新治疗方法的最佳给药顺序。本综述的目的是介绍它们各自的预测和评估因素，并提出潜在的给药顺序。
使用以下关键词检索PubMed医学文献引用数据库：前列腺癌、去势抵抗、转移、靶向治疗、治疗顺序、免疫治疗和临床试验。还纳入了最近欧洲和北美大会的报告。
迄今为止，尚未明确确定这些新疗法的预测因素，但 Gleason 评分不少于8分以及接受过一次或多次化疗似乎预示着阿比特龙的疗效较低。值得进一步研究的有前景的因素包括循环肿瘤细胞计数及其每次治疗的变化、ERG 突变状态或肿瘤内雄激素状态。尚未报道替代标准，但与所有激素疗法一样，PSA 水平的变化是阿比特龙疗效的重要指标。去势抵抗患者的最佳治疗顺序仍有待确定。
尽管最近有新的分子可用，但使用它们的经验有限。因此，目前尚无反应率和治疗结果的预测标志物，也没有关于CRPC患者最佳治疗顺序的数据。
