Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Ann Oncol. 2019 Oct 1;30(10):1591-1600. doi: 10.1093/annonc/mdz210.
Androgen-deprivation therapy (ADT) has been the mainstay of treatment of metastatic prostate cancer since the first report of its hormonal dependence in the 1940s. Since 2015, the addition of docetaxel and the addition of abiraterone to ADT have conferred substantial overall survival benefit in men with metastatic castration-naïve prostate cancer (mCNPC). The shift of these treatment options for metastatic prostate cancer from the castration-resistant setting to the castration-naïve setting has led to new challenges in the management of this disease. It remains to be determined which patients may benefit most from either early concomitant docetaxel or from abiraterone with ADT, since biomarkers for early therapy response and risk stratification are currently lacking. Therefore, the ability to personalize medicine is hampered. Furthermore, the earlier detection of metastatic prostate cancer by using new imaging modalities makes the application of clinical trial results in daily practice increasingly challenging. Recently, both local radiotherapy to the primary tumor combined with ADT and abiraterone combined with ADT showed a survival benefit in low-volume disease patients. The latest data also demonstrated a survival benefit with the addition of apalutamide or enzalutamide to ADT. The extent of metastatic disease may become one of the most important factors to determine treatment choice. In this review article, we summarize trial data to provide guidance for treatment selection in metastatic castration-naïve prostate cancer.
自上世纪 40 年代首次报道前列腺癌的激素依赖性以来，雄激素剥夺疗法（ADT）一直是治疗转移性前列腺癌的主要方法。自 2015 年以来，在转移性去势敏感前列腺癌（mCNPC）患者中，多西他赛的加入和阿比特龙联合 ADT 均显著提高了总生存期。这些转移性前列腺癌的治疗方案从去势抵抗性环境转移到去势敏感性环境，给这种疾病的管理带来了新的挑战。目前尚缺乏早期治疗反应和风险分层的生物标志物，因此，尚不确定哪些患者可能从早期联合多西他赛或阿比特龙联合 ADT 中获益最多。因此，个性化医疗的能力受到阻碍。此外，新的影像学检查方法更早地发现转移性前列腺癌，使得临床试验结果在日常实践中的应用越来越具有挑战性。最近，原发肿瘤局部放疗联合 ADT 和阿比特龙联合 ADT 均显示出对低容量疾病患者的生存获益。最新数据还表明，ADT 联合阿帕鲁胺或恩扎鲁胺可提高生存获益。转移性疾病的范围可能成为决定治疗选择的最重要因素之一。在这篇综述文章中，我们总结了试验数据，为转移性去势敏感前列腺癌的治疗选择提供了指导。
