Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Institute of Urology and Andrology, Karl Landsteiner Society, Krems an der Donau, Austria.
Curr Opin Urol. 2020 Jul;30(4):527-533. doi: 10.1097/MOU.0000000000000784.
Indications for chemotherapy have increased in prostate cancer (PCA), many of which are shared with new hormonal agents (NHA). With no head to head comparison available, defining the optimal sequence and identifying biomarkers to predict response, has been a focus of intense research in PCA. We aim to summarize the best currently available evidence in all stages of disease to help guide therapy.
In metastatic castration-resistant prostate cancer, Cabazitaxel has shown improved radiographic progression-free survival over another NHA after Docetaxel and one NHA. For hormone sensitive PCA (mHSPC) multiple meta-analyses have shown combination therapy with Docetaxel or an NHA to be superior to androgen deprivation therapy alone, yet no clear benefit over each other. For peri-interventional chemotherapy with local therapy, there is currently only one positive prospective trial, for very high-risk disease.
Cabazitaxel is underutilized and should be used earlier. NHAs should not be used in succession as there is significant cross resistance. Combination therapy should be used in mHSPC, yet there is no clear benefit for any combination. Peri-interventional chemotherapy might have a benefit for a small group of patients with very high-risk disease, yet this must be carefully evaluated, and side effects must be taken into account.
目的综述：前列腺癌（PCA）的化疗适应证有所增加，其中许多与新的激素药物（NHA）的适应证重叠。由于缺乏头对头比较，因此确定最佳的治疗顺序和预测反应的生物标志物一直是 PCA 研究的重点。我们旨在总结目前在疾病的各个阶段中最佳的现有证据，以帮助指导治疗。
最新发现：在转移性去势抵抗性前列腺癌中，卡巴他赛在多西他赛和另一种 NHA 之后显示出改善的影像学无进展生存期，优于另一种 NHA。对于激素敏感的 PCA（mHSPC），多项荟萃分析表明，与单独雄激素剥夺疗法相比，Docetaxel 或 NHA 的联合治疗具有优势，但彼此之间没有明显的优势。对于局部治疗的围手术期化疗，目前只有一项针对高危疾病的阳性前瞻性试验。
总结：卡巴他赛的应用不足，应该更早使用。由于存在显著的交叉耐药性，NHA 不应连续使用。mHSPC 应采用联合治疗，但任何联合治疗均无明显获益。围手术期化疗可能对一小部分高危疾病患者有益，但必须仔细评估，且必须考虑副作用。
