Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Cancer Lett. 2021 Oct 28;519:20-29. doi: 10.1016/j.canlet.2021.06.010. Epub 2021 Jun 18.
The treatment landscape of metastatic prostate cancer has evolved significantly over the past two decades. Several landmark phase 3 trials led to new drug approvals and rapid changes in therapy options for patients, including drugs with distinct mechanisms of action (e.g., hormonal, chemotherapy, radionuclide, immunotherapy, and targeted therapies). Therapies initially developed in later stages of the disease (metastatic castration resistant prostate cancer) have started to move earlier in the prostate cancer continuum, with new standards of care for metastatic hormone naive prostate cancer and non-metastatic castration resistant prostate cancer. Overall, patients are living longer with a better quality of life. However, despite these significant advances, prostate cancer remains a leading cause of cancer death globally. Disease heterogeneity and the emergence of therapy resistance remain significant barriers, and the identification and application of molecular biomarkers to guide the choice and sequencing of systemic agents are still in early stages. Here we discuss the current treatment landscape of metastatic prostate cancer, clinical challenges, and the emerging role of molecular biomarkers for targeting biologic subsets of advanced disease and co-targeting heterogenous resistance patterns.
过去二十年中，转移性前列腺癌的治疗格局发生了重大变化。几项具有里程碑意义的 III 期临床试验带来了新药的批准，并迅速改变了患者的治疗选择，包括具有不同作用机制的药物（例如，激素、化疗、放射性核素、免疫疗法和靶向疗法）。最初在疾病晚期（转移性去势抵抗性前列腺癌）开发的疗法已经开始在前列腺癌连续体中更早地应用，转移性去势敏感性前列腺癌和非转移性去势抵抗性前列腺癌有了新的治疗标准。总体而言，患者的生存期更长，生活质量更好。然而，尽管取得了这些重大进展，前列腺癌仍然是全球癌症死亡的主要原因。疾病异质性和治疗耐药性的出现仍然是重大障碍，识别和应用分子生物标志物来指导系统药物的选择和序贯应用仍处于早期阶段。本文讨论了转移性前列腺癌的当前治疗格局、临床挑战以及分子生物标志物在靶向晚期疾病的生物学亚群和共同靶向异质性耐药模式方面的新兴作用。
