转移性去势抵抗性前列腺癌男性患者的全身治疗：美国临床肿瘤学会和安大略癌症护理临床实践指南
Systemic therapy in men with metastatic castration-resistant prostate cancer:American Society of Clinical Oncology and Cancer Care Ontario clinical practice guideline.
作者信息
Basch Ethan, Loblaw D Andrew, Oliver Thomas K, Carducci Michael, Chen Ronald C, Frame James N, Garrels Kristina, Hotte Sebastien, Kattan Michael W, Raghavan Derek, Saad Fred, Taplin Mary-Ellen, Walker-Dilks Cindy, Williams James, Winquist Eric, Bennett Charles L, Wootton Ted, Rumble R Bryan, Dusetzina Stacie B, Virgo Katherine S
机构信息
Ethan Basch, Ronald C. Chen, and Stacie B. Dusetzina, University of North Carolina, Chapel Hill; Derek Raghavan, Carolinas Health Care/Levine Cancer Institute, Charlotte, NC; D. Andrew Loblaw, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Ted Wootton, Patient Representatives, Toronto; Sebastian Hotte and Cindy Walker-Dilks, McMaster University; Cindy Walker-Dilks, Cancer Care Ontario, Hamilton; Eric Winquist, London Health Sciences Centre, London, Ontario; Fred Saad, University of Montreal, Montreal, Quebec, Canada; Thomas K. Oliver and R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Michael Carducci, Johns Hopkins University, Baltimore, MD; James N. Frame, Charleston Area Medical Center Health Systems, Charleston, WV; Kristina Garrels, Private Practice, Fargo, ND; Michael W. Kattan, Cleveland Clinic, Cleveland, OH; Mary-Ellen Taplin, Dana-Farber Cancer Institute, Boston, MA; James Williams, Pennsylvania Prostate Cancer Coalition, Camp Hill, PA; Charles L. Bennett, South Carolina College of Pharmacy, Columbia, SC; and Katherine S. Virgo, Emory University, Atlanta, GA.
出版信息
J Clin Oncol. 2014 Oct 20;32(30):3436-48. doi: 10.1200/JCO.2013.54.8404. Epub 2014 Sep 8.
PURPOSE
To provide treatment recommendations for men with metastatic castration-resistant prostate cancer (CRPC).
METHODS
The American Society of Clinical Oncology and Cancer Care Ontario convened an expert panel to develop evidence-based recommendations informed by a systematic review of the literature.
RESULTS
When added to androgen deprivation, therapies demonstrating improved survival, improved quality of life (QOL), and favorable benefit-harm balance include abiraterone acetate/prednisone, enzalutamide, and radium-223 ((223)Ra; for men with predominantly bone metastases). Improved survival and QOL with moderate toxicity risk are associated with docetaxel/prednisone. For asymptomatic/minimally symptomatic men, improved survival with unclear QOL impact and low toxicity are associated with sipuleucel-T. For men who previously received docetaxel, improved survival, unclear QOL impact, and moderate to high toxicity risk are associated with cabazitaxel/prednisone. Modest QOL benefit (without survival benefit) and high toxicity risk are associated with mitoxantrone/prednisone after docetaxel. No benefit and excess toxicity are observed with bevacizumab, estramustine, and sunitinib.
RECOMMENDATIONS
Continue androgen deprivation (pharmaceutical or surgical) indefinitely. Abiraterone acetate/prednisone, enzalutamide, or (223)Ra should be offered; docetaxel/prednisone should also be offered, accompanied by discussion of toxicity risk. Sipuleucel-T may be offered to asymptomatic/minimally symptomatic men. For men who have experienced progression with docetaxel, cabazitaxel may be offered, accompanied by discussion of toxicity risk. Mitoxantrone may be offered, accompanied by discussion of limited clinical benefit and toxicity risk. Ketoconazole or antiandrogens (eg, bicalutamide, flutamide, nilutamide) may be offered, accompanied by discussion of limited known clinical benefit. Bevacizumab, estramustine, and sunitinib should not be offered. There is insufficient evidence to evaluate optimal sequences or combinations of therapies. Palliative care should be offered to all patients.
目的
为转移性去势抵抗性前列腺癌（CRPC）男性患者提供治疗建议。
方法
美国临床肿瘤学会和安大略癌症护理组织召集了一个专家小组，通过对文献的系统回顾制定基于证据的建议。
结果
在雄激素剥夺治疗基础上，显示能提高生存率、改善生活质量（QOL）且获益-风险平衡良好的治疗方法包括醋酸阿比特龙/泼尼松、恩杂鲁胺和镭-223（²²³Ra；用于以骨转移为主的男性患者）。多西他赛/泼尼松与生存率提高和生活质量改善相关，但毒性风险中等。对于无症状/症状轻微的男性患者，西妥昔单抗与生存率提高相关，但对生活质量的影响不明且毒性较低。对于先前接受过多西他赛治疗的男性患者，卡巴他赛/泼尼松与生存率提高、对生活质量的影响不明以及中度至高度毒性风险相关。多西他赛后，米托蒽醌/泼尼松与适度的生活质量获益（无生存获益）和高毒性风险相关。贝伐单抗、雌莫司汀和舒尼替尼未显示出获益且毒性过大。
建议
无限期持续进行雄激素剥夺治疗（药物或手术）。应提供醋酸阿比特龙/泼尼松、恩杂鲁胺或²²³Ra；也应提供多西他赛/泼尼松，并讨论毒性风险。对于无症状/症状轻微的男性患者，可提供西妥昔单抗。对于多西他赛治疗后病情进展的男性患者，可提供卡巴他赛，并讨论毒性风险。可提供米托蒽醌，并讨论有限的临床获益和毒性风险。可提供酮康唑或抗雄激素药物（如比卡鲁胺、氟他胺、尼鲁米特）并讨论已知的有限临床获益。不应提供贝伐单抗、雌莫司汀和舒尼替尼。评估治疗的最佳顺序或联合方案的证据不足。应为所有患者提供姑息治疗。
Zotero 插件