Department of Medical Oncology, Ankara University School of Medicine, Ankara; Ankara University Cancer Research Institute, Ankara, Turkey.
Dana-Farber Cancer Institute, Harvard Medical School, Boston.
ESMO Open. 2024 Nov;9(11):103736. doi: 10.1016/j.esmoop.2024.103736. Epub 2024 Oct 18.
Prostate cancer represents a major global health challenge, necessitating efficacious therapeutic strategies. Androgen receptor pathway inhibitors (ARPIs) have become central to prostate cancer treatment, demonstrating significant effectiveness in both metastatic and non-metastatic contexts. Abiraterone acetate, by inhibiting androgen synthesis, deprives cancer cells androgens necessary for growth, while second-generation androgen receptor (AR) antagonists disrupt AR signaling by blocking AR binding, thereby impeding tumor progression. Given the predominance of prostate cancer in the elderly, who often present with multiple comorbidities requiring complex pharmacological regimens, the potential for drug-drug interactions with ARPIs is a critical concern. These interactions, particularly through pathways like CYP2D6 inhibition by abiraterone and CYP3A4 induction by enzalutamide and apalutamide, necessitate a thorough understanding to optimize therapeutic outcomes and minimize adverse effects. This review aims to delineate the efficacy of ARPIs in prostate cancer management and elucidate their interaction with common medications, highlighting the importance of vigilant drug management to optimize patient care.
前列腺癌是一个全球性的重大健康挑战，需要有效的治疗策略。雄激素受体通路抑制剂（ARPI）已成为前列腺癌治疗的核心，在转移性和非转移性环境中均显示出显著的疗效。醋酸阿比特龙通过抑制雄激素合成，剥夺了癌细胞生长所需的雄激素，而第二代雄激素受体（AR）拮抗剂通过阻断 AR 结合来阻断 AR 信号，从而阻止肿瘤进展。鉴于前列腺癌在老年人中更为常见，而老年人通常患有多种需要复杂药物治疗方案的合并症，因此与 ARPI 发生药物相互作用的可能性是一个关键问题。这些相互作用，特别是通过 CYP2D6 抑制（由阿比特龙引起）和 CYP3A4 诱导（由恩扎鲁胺和阿帕鲁胺引起）等途径，需要深入了解以优化治疗效果并最小化不良反应。本综述旨在阐明 ARPI 在前列腺癌管理中的疗效，并阐明它们与常见药物的相互作用，强调了警惕药物管理以优化患者护理的重要性。
