Petrioli Roberto, Francini Edoardo, Roviello Giandomenico
Roberto Petrioli, Giandomenico Roviello, Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
World J Clin Oncol. 2015 Oct 10;6(5):99-103. doi: 10.5306/wjco.v6.i5.99.
Three-weekly docetaxel plus prednisone is the standard first-line cytotoxic treatment for patients with metastatic castrate-resistant prostate cancer (mCRPC). Today, several new treatment options are available for patients with tumor progression after first-line docetaxel: Abiraterone, enzalutamide, cabazitaxel, sipuleucel-T immunotherapy, and the radionuclide radium-223. However, despite the evolving scenario in CRPC treatment, the optimal sequencing of the innovative therapies remains unclear. The reintroduction of docetaxel at the occurrence of disease progression after a drug holiday (docetaxel rechallenge) was often proposed, and this chemotherapeutic agent showed to maintain antitumor activity in mCRPC patients. Docetaxel rechallenge may still constitute a valid treatment option mainly for patients with favorable response to first-line docetaxel, at least > 3 mo progression-free interval, age less than 75 years, good performance status, and acceptable docetaxel toxicity. The risk of cumulative toxicity must be evaluated, since sensory neuropathy, nail disorders and fatigue might occur on docetaxel rechallenge.
每三周一次的多西他赛联合泼尼松是转移性去势抵抗性前列腺癌（mCRPC）患者的标准一线细胞毒性治疗方案。如今，对于一线多西他赛治疗后出现肿瘤进展的患者，有几种新的治疗选择：阿比特龙、恩杂鲁胺、卡巴他赛、 sipuleucel-T免疫疗法以及放射性核素镭-223。然而，尽管CRPC治疗的情况不断演变，但创新疗法的最佳序贯治疗仍不明确。在停药期后疾病进展时重新引入多西他赛（多西他赛再挑战）的做法经常被提出，并且这种化疗药物在mCRPC患者中显示出维持抗肿瘤活性。多西他赛再挑战可能仍然是一种有效的治疗选择，主要适用于对一线多西他赛反应良好的患者，至少无进展生存期>3个月、年龄小于75岁、身体状况良好且多西他赛毒性可接受。必须评估累积毒性的风险，因为在多西他赛再挑战时可能会出现感觉神经病变、指甲疾病和疲劳。
