Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts.
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Clin Adv Hematol Oncol. 2023 Jun;21(6):321-340.
Prostate cancer is the most frequently diagnosed non-skin cancer and the second leading cause of cancer-related mortality in men in the United States. Over the past decade, the treatment landscape for advanced prostate cancer has rapidly shifted. For decades, androgen deprivation therapy has been the cornerstone of systemic treatment for patients with metastatic hormone-sensitive prostate cancer (mHSPC). However, more recently, we have seen the emergence of doublet and triplet combinations in the mHSPC setting. At the same time, there is an expanding list of treatments for patients with metastatic castration-resistant prostate cancer (mCRPC), including hormonal treatments, chemotherapy, immunotherapy, bone-targeted agents, radioligand therapy, and targeted therapy. The shifting of the treatment landscape for advanced prostate cancer has raised many questions regarding patient selection, therapy choice, and sequencing of different approved agents, particularly in the mCRPC setting with the earlier use of chemotherapy and androgen receptor signaling inhibitors. Since then, multiple trials have been conducted to improve the management of mHSPC and delay its progression to mCRPC. This review article discusses various clinical trials that focus on novel therapeutic targets for prostate cancer and how the initiation of newer clinical trials has affected older therapies and trials.
前列腺癌是美国男性中最常见的非皮肤癌，也是癌症相关死亡的第二大主要原因。在过去的十年中，晚期前列腺癌的治疗格局发生了迅速变化。几十年来，雄激素剥夺疗法一直是转移性激素敏感前列腺癌（mHSPC）患者系统治疗的基石。然而，最近，我们在 mHSPC 环境中看到了双重和三重组合的出现。与此同时，转移性去势抵抗性前列腺癌（mCRPC）患者的治疗方法不断增加，包括激素治疗、化疗、免疫疗法、骨靶向药物、放射性配体治疗和靶向治疗。晚期前列腺癌治疗格局的转变引发了许多关于患者选择、治疗选择以及不同批准药物序贯的问题，特别是在 mCRPC 环境中，化疗和雄激素受体信号抑制剂的早期使用。此后，进行了多项临床试验以改善 mHSPC 的管理并延迟其进展为 mCRPC。本文讨论了专注于前列腺癌新治疗靶点的各种临床试验，以及新临床试验的启动如何影响旧疗法和试验。
