Bastin Julie, Werbrouck Emilie, Verbiest Annelies, Punie Kevin, Bechter Oliver, Woei-A-Jin Feng Jung, Wolter Pascal, Wildiers Hans, Lerut Evelyne, Dumez Herlinde, Decallonne Brigitte, Clement Paul, Vanderschueren Dirk, Albersen Maarten, Oyen Raymond, Schöffski Patrick, Beuselinck Benoit
a Department of General Medical Oncology , University Hospitals Leuven, Leuven Cancer Institute, KULeuven , Leuven , Belgium.
b Department of General Medical Oncology , St. Nikolaus-Hospital Eupen , Eupen , Belgium.
Acta Clin Belg. 2019 Jun;74(3):169-179. doi: 10.1080/17843286.2018.1476115. Epub 2018 May 18.
To study the prevalence of hypogonadism in male patients with metastatic renal cell carcinoma (mRCC) starting with targeted therapies and the impact of the vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) sunitinib and pazopanib on the luteinizing hormone (LH)/testosterone (TT)-axis.
Male mRCC patients starting with targeted therapies were prospectively included in this study. TT- and LH-levels were sampled at start as well as during systemic therapy. Endpoints of the study were gonadal status (TT- and LH-levels) at start of targeted therapy and TT- and LH-evolution during targeted therapy.
Sixty-three patients were included in this study. At start of targeted therapy, 30% of patients were eugonadal and 48% had secondary hypogonadism. Decreased TT- and increased LH-levels were associated with inflammatory state and poor prognosis. During sunitinib therapy, TT-levels decreased with 32% (p = 0.004) and LH-levels with 14% (p = 0.03). TT-levels were 13% lower (p = 0.007) and LH-levels 15% lower (p = 0.004) on day 28 compared to day 1. In four patients, a dramatic TT decrease was observed shortly after starting sunitinib. In patients treated with pazopanib, no impact on TT- or LH-levels was observed.
Hypogonadism is a frequent finding in male mRCC-patients at start of targeted therapies. In contrast to pazopanib, during sunitinib therapy, TT- and LH-levels tend to decrease, leading to an increased incidence of secondary hypogonadism.
研究开始接受靶向治疗的转移性肾细胞癌（mRCC）男性患者性腺功能减退的患病率，以及血管内皮生长因子受体酪氨酸激酶抑制剂（VEGFR-TKIs）舒尼替尼和帕唑帕尼对促黄体生成素（LH）/睾酮（TT）轴的影响。
开始接受靶向治疗的男性mRCC患者被前瞻性纳入本研究。在开始治疗时以及全身治疗期间采集TT和LH水平。研究的终点是靶向治疗开始时的性腺状态（TT和LH水平）以及靶向治疗期间TT和LH的变化情况。
本研究纳入了63例患者。在靶向治疗开始时，30%的患者性腺功能正常，48%的患者有继发性性腺功能减退。TT水平降低和LH水平升高与炎症状态及预后不良相关。在舒尼替尼治疗期间，TT水平下降了32%（p = 0.004），LH水平下降了14%（p = 0.03）。与第1天相比，第28天时TT水平低13%（p = 0.007），LH水平低15%（p = 0.004）。在4例患者中，开始使用舒尼替尼后不久观察到TT急剧下降。在接受帕唑帕尼治疗的患者中，未观察到对TT或LH水平的影响。
性腺功能减退在开始靶向治疗的男性mRCC患者中很常见。与帕唑帕尼不同，在舒尼替尼治疗期间，TT和LH水平往往会下降，导致继发性性腺功能减退的发生率增加。
