Vaishampayan Ulka N
Karmanos Cancer Institute/Wayne State University, Detroit, Michigan, USA.
Curr Opin Oncol. 2017 May;29(3):196-200. doi: 10.1097/CCO.0000000000000370.
Prostate cancer presents with a multitude of faces. It ranges from localized cancers staying quiescent for many years during active surveillance to the raging diffuse liver metastases causing terminal disease. The incidence of metastatic disease is increasing. This review will highlight some of the recent developments as well as ongoing challenges of managing advanced prostate cancer.
Significant strides are being made in managing metastatic prostate cancer. With the evolution of multiple new therapies, now the optimal use of these therapies and their proper sequencing is being addressed. Research is ongoing for mapping out pathways of resistance to therapies and for discovering new targets. Genomic alterations and abnormalities in circulating tumor DNA are being detected and will hopefully lead us more toward biomarker based therapies. The next era in oncology belongs to immune therapy. However, in prostate cancer the immune checkpoint inhibitors have shown modest responses and a phase III trial of radiation therapy ± ipilimumab revealed no benefit. Efforts are ongoing with combination trials of enzalutamide and atezolizumab or pembrolizumab. PARP inhibitors are gradually being established for therapeutic purposes, with olaparib achieving breakthrough status for prostate cancer patients with BRCA1 and 2 and ATM mutations.
The future will bring an era of personalized medicine in advanced prostate cancer as well as optimization and more strategic sequencing of existing therapies.
前列腺癌呈现出多种表现形式。从在积极监测期间多年保持静止的局限性癌症，到导致终末期疾病的迅猛扩散的肝转移癌。转移性疾病的发病率正在上升。本综述将重点介绍晚期前列腺癌管理方面的一些最新进展以及持续存在的挑战。
在转移性前列腺癌的管理方面正在取得重大进展。随着多种新疗法的发展，目前正在探讨这些疗法的最佳使用及其合理的用药顺序。针对绘制治疗耐药途径和发现新靶点的研究正在进行。正在检测循环肿瘤DNA中的基因组改变和异常情况，有望引领我们更多地走向基于生物标志物的疗法。肿瘤学的下一个时代属于免疫疗法。然而，在前列腺癌中，免疫检查点抑制剂的反应较为温和，一项放疗±伊匹单抗的III期试验未显示出益处。正在进行恩杂鲁胺与阿特珠单抗或帕博利珠单抗联合试验。PARP抑制剂正逐渐确立其治疗用途，奥拉帕尼在携带BRCA1、2和ATM突变的前列腺癌患者中获得了突破性地位。
未来将迎来晚期前列腺癌个性化医疗的时代，以及现有疗法的优化和更具策略性的用药顺序。
