Department of Medical Oncology, Institut Paoli-Calmettes, 232 boulevard Sainte-Marguerite, BP 156, 13273 Marseille, France.
Department of Urology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France, Assistance Publique Hôpitaux de Paris et Université Paris Descartes, France.
Cancer Treat Rev. 2017 Apr;55:211-217. doi: 10.1016/j.ctrv.2016.09.008. Epub 2016 Sep 10.
Data from the literature support with strong evidence the addition of docetaxel to androgen-deprivation therapy (ADT) for men with metastatic prostate cancer, and starting therapy for the first time. A meta-analysis of three randomized controlled trials showed a significant improvement of overall survival when ADT was combined with docetaxel when compared to ADT alone (HR=0.77; 95% CI: 0.68-0.87; p<0.0001). Consequently, combination therapy should be considered presently as the new standard of care, using 6 cycles of docetaxel, without prednisone. However, candidates for this upfront combination therapy in whom the balance between its side effects and benefits is favorable are still to be identified more precisely. Patients' stratification according to Gleason score, previous local treatment and age or performance status were shown to have a prognostic impact. The volume of metastases, as defined in the CHAARTED study for instance, could be an interesting predictive factor. However, data accumulated until now remain only hypothesis generating and further analysis and studies are needed to establish any potential discriminating factors. Several new efficient therapeutic options are now available in prostate cancer management and should be evaluated against a chemo-hormonal combination therapy. Other trials are warranted to establish the role of docetaxel in earlier stages of the disease, the combination with the new hormonal therapies as well as the best management options after docetaxel.
文献中的数据有力地支持了在转移性前列腺癌患者中，将多西他赛添加到去势治疗（ADT）中，并且首次开始治疗。三项随机对照试验的荟萃分析显示，与单独 ADT 相比，ADT 联合多西他赛可显著提高总生存期（HR=0.77；95%CI：0.68-0.87；p<0.0001）。因此，目前应将联合治疗视为新的治疗标准，使用 6 个周期的多西他赛，而无需使用泼尼松。然而，仍需更精确地确定哪些患者适合这种初始联合治疗，并且平衡其副作用和益处。根据格里森评分、以前的局部治疗以及年龄或表现状态对患者进行分层，显示出具有预后影响。例如，CHAARTED 研究中定义的转移病灶体积可能是一个有趣的预测因素。然而，迄今为止积累的数据仅具有假设生成作用，需要进一步分析和研究以确定任何潜在的鉴别因素。在前列腺癌管理中，现在有几种新的有效治疗选择，应将其与化疗-激素联合治疗进行评估。还需要进行其他试验来确定多西他赛在疾病早期阶段的作用、与新的激素治疗的联合作用以及多西他赛后的最佳管理选择。
