Omlin Aurelius, Pezaro Carmel, Gillessen Sommer Silke
Kantonsspital St Gallen, Abteilung fuer Medizinische Onkologie, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland.
Monash University Eastern Health Clinical School, Australia.
Ther Adv Urol. 2014 Feb;6(1):3-14. doi: 10.1177/1756287213509677.
In the last three years, five novel treatments have been shown to improve survival in metastatic castration-resistant prostate cancer (CRPC). These novel treatments have distinct mechanisms of action: tubulin-binding chemotherapy (cabazitaxel); immunotherapy (sipuleucel-T); CYP-17 inhibition (abiraterone); androgen receptor (AR) blockade (enzalutamide); and radioisotope therapy (radium-223). For a number of years, docetaxel was the only treatment with a proven survival benefit for patients with CRPC. Therefore, somewhat artificially, three treatment spaces for drug development in CRPC have emerged: pre-docetaxel; docetaxel combinations; and post-docetaxel. For patients progressing after docetaxel-based chemotherapy, treatment options available outside of clinical trials now include abiraterone, cabazitaxel and enzalutamide. Prospective data on how to best use these novel agents sequentially are not available. Clinicians face the difficult task of choosing between treatment options for individual patients to maximize patient benefit. Treatment evaluation in patients with CRPC remains challenging due to the predominance of bone metastatic disease and the lack of validated surrogate markers for survival. This review summarizes the data available with regards to sequencing of the novel treatments for CRPC.
在过去三年中，已有五种新型疗法被证明可提高转移性去势抵抗性前列腺癌（CRPC）患者的生存率。这些新型疗法具有不同的作用机制：微管结合化疗（卡巴他赛）；免疫疗法（ sipuleucel-T）；CYP-17抑制（阿比特龙）；雄激素受体（AR）阻断（恩杂鲁胺）；以及放射性同位素疗法（镭-223）。多年来，多西他赛是唯一一种已证实对CRPC患者有生存获益的治疗方法。因此，在某种程度上人为地出现了CRPC药物开发的三个治疗领域：多西他赛之前；多西他赛联合用药；以及多西他赛之后。对于接受基于多西他赛的化疗后病情进展的患者，目前临床试验之外可用的治疗选择包括阿比特龙、卡巴他赛和恩杂鲁胺。关于如何最佳序贯使用这些新型药物的前瞻性数据尚不可用。临床医生面临着为个体患者在治疗选择之间做出抉择以最大化患者获益的艰巨任务。由于骨转移疾病占主导且缺乏用于生存的经过验证的替代标志物，CRPC患者的治疗评估仍然具有挑战性。本综述总结了关于CRPC新型治疗序贯的现有数据。
