Schutz Fabio Augusto Barros, Sirachainan Ekaphop, Kuppusamy Shanggar, Hoa Nguyen Thi Thai, Dejthevaporn Thitiya, Bahadzor Badrulhisham, Toan Vu Quang, Chansriwong Phichai, Alip Adlinda, Hue Nguyen Thi Minh, Parinyanitikul Napa, Tan Ai Lian, Hoang Vu Dinh Khanh, Tienchaiananda Piyawan, Chinchapattanam Sai Naga Deepak, Garg Amit
Department of Medical Oncology, Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil.
Ramathibodi Hospital, Bangkok, Thailand.
Ther Adv Med Oncol. 2021 Feb 23;13:1758835920985464. doi: 10.1177/1758835920985464. eCollection 2021.
Clinical decision making is challenging in men with metastatic prostate cancer (mPC), as heterogeneity in treatment options and patient characteristics have resulted in multiple scenarios with little or no evidence. The South East Asia Expert Panel 2019 addressed some of these challenges.
Based on evidence in the literature and expert interviews, 19 statements were formulated for key challenges in the treatment of men with castration-sensitive and -resistant prostate cancer in clinical practice. A modified Delphi process was used to reach consensus among experts in the panel and develop clinical practice recommendations.
The majority of the panel preferred a risk-based stratification and recommended abiraterone or enzalutamide as first-line therapy for symptomatic chemotherapy naïve patients. Abiraterone is preferred over enzalutamide as a first-line treatment in these patients. However, the panel did not support the use of abiraterone in high risk lymph-node positive only (N+M0) or in non-metastatic (N0M0) patients. In select patients, low dose abiraterone with food may be used to optimize clinical outcomes. Androgen receptor gene splice variant status may be a useful guide to therapy. In addition, generic versions of approved therapies may improve access to treatment to a broader patient population. The choice of treatment, as well as sequencing are guided by both patient and disease characteristics, preferences, drug access, cost, and compliance.
Expert recommendations are key to guidance for the optimal management of mPC. Appropriate choice, timing, and sequence of treatment options can help to tailor therapy to maximize outcomes in men with mPC.
对于转移性前列腺癌（mPC）男性患者而言，临床决策颇具挑战性，因为治疗方案和患者特征的异质性导致了多种几乎没有证据或完全没有证据的情况。2019年东南亚专家小组解决了其中一些挑战。
基于文献证据和专家访谈，针对临床实践中去势敏感性和去势抵抗性前列腺癌男性患者治疗的关键挑战制定了19条声明。采用改良的德尔菲法在专家小组中达成共识并制定临床实践建议。
大多数专家小组倾向于基于风险的分层，并推荐阿比特龙或恩杂鲁胺作为初治有症状患者的一线治疗。在这些患者中，阿比特龙作为一线治疗比恩杂鲁胺更受青睐。然而，专家小组不支持仅在高风险淋巴结阳性（N + M0）或非转移性（N0M0）患者中使用阿比特龙。在特定患者中，低剂量阿比特龙与食物同服可用于优化临床结局。雄激素受体基因剪接变异状态可能是治疗的有用指导。此外，已批准疗法的仿制药版本可能会使更多患者能够获得治疗。治疗的选择以及治疗顺序由患者和疾病特征、偏好、药物可及性、成本和依从性共同指导。
专家建议是指导mPC最佳管理的关键。合适的治疗选择、时机和顺序有助于量身定制治疗方案，以使mPC男性患者的治疗效果最大化。
