Mir Nabiel, Burke Olivia, Yates Samuel, Rajasekaran Tanujaa, Chan Johan, Szmulewitz Russell, Kanesvaran Ravindran
Section of Hematology/Oncology, Department of Medicine, The University of Chicago, 5841 S Maryland Avenue, Chicago, IL 60637, USA.
Hospice and Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Ther Adv Med Oncol. 2023 Jan 28;15:17588359221149887. doi: 10.1177/17588359221149887. eCollection 2023.
Prostate cancer is a disease of older adults that has undergone a significant therapeutic paradigm shift in the last decade with the emergence of novel androgen receptor pathway inhibitors (ARPis). One of the more commonly used ARPis is enzalutamide. This drug, along with darolutamide and apalutamide, initially received approvals in the metastatic castrate-resistant prostate cancer setting but is now utilized frequently in the metastatic castrate-sensitive and non-metastatic castration-resistant settings. Landmark phase III data illustrating ARPi efficacy in older adults are limited to those with excellent performance status. However, its role in unfit older prostate cancer patients remains to be explored in the context of a narrative review. This first-of-its-kind drug review aims to shed light on the most up-to-date evidence behind the unique toxicity profile of ARPis in the context of geriatric vulnerabilities such as cognitive and functional impairment, along with potential solutions and supporting evidence that exists to circumvent these issues in the vulnerable older adult.
前列腺癌是一种老年疾病，在过去十年中，随着新型雄激素受体途径抑制剂（ARPis）的出现，其治疗模式发生了重大转变。恩杂鲁胺是常用的ARPis之一。这种药物与达洛鲁胺和阿帕鲁胺一起，最初在转移性去势抵抗性前列腺癌的治疗中获得批准，但现在也经常用于转移性去势敏感性和非转移性去势抵抗性前列腺癌的治疗。标志性的III期数据表明，ARPis在老年患者中的疗效仅限于那些身体状况良好的患者。然而，在一篇叙述性综述的背景下，ARPis在身体状况不佳的老年前列腺癌患者中的作用仍有待探索。这篇首创的药物综述旨在揭示ARPis独特毒性特征背后的最新证据，这些证据与老年患者的认知和功能损害等脆弱性有关，同时还探讨了潜在的解决方案以及支持在脆弱的老年患者中规避这些问题的证据。
