Kania Brooke, Sharma Kirthana, Ramatlho Pleasure, Vuylsteke Peter, Ndlovu Andrew, Mayer Tina
Department of Internal Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Rutgers Global Health Institute, New Brunswick, NJ, USA.
Transl Cancer Res. 2024 Nov 30;13(11):6503-6510. doi: 10.21037/tcr-23-2289. Epub 2024 Jul 16.
Prostate cancer (CaP) represents a significant cause of cancer-related mortality on a global scale. Low- and middle-income countries (LMIC), particularly those in sub-Saharan Africa (SSA), face a disproportionate burden of this disease. Underlying genetic factors as well as barriers to early diagnosis and treatment lead to overall worse outcomes for CaP patients in SSA compared with the United States (U.S.). The number of available therapies for CaP has exploded over the last decade. Discussion of the potential impact these therapies could have on the current management of patients with metastatic CaP in SSA may help to prioritize goals for making drugs available to more patients. We review U.S. Food and Drug Administration (FDA)-approved treatments for metastatic CaP while acknowledging that many of these treatment regimens may not be feasible in SSA given barriers to medication access, significant follow-up required, and limited technological advancements needed to diagnose and treat. The purpose of this manuscript is to aid readers who may be unfamiliar with the currently approved regimens for CaP in the U.S. to provide information that may aid in prioritization of the available therapies for this cancer in SSA. Given our review of both the treatment of CaP in SSA and current treatment options available in the U.S., abiraterone has demonstrated remarkable benefits in advanced CaP and has been well-tolerated. Abiraterone and prednisone combination therapy has demonstrated significant survival benefit to patients in multiple phase three trials and given it was the first of the newer generation hormone therapies to become available, generic options are available allowing for a cost-effective option for patients. Studies have demonstrated similar efficacy when administering low-dose abiraterone taken with a low-fat meal (compared to full dose taken when fasting), which can lead to cost-savings if the drug is at a lower dose. In conclusion, abiraterone and prednisone can be clinically meaningful for patients in SSA and has a favorable and manageable side effect profile. Additional treatment options also have meaningful benefits; however, the absolute benefit of abiraterone as well as the ease of administration would favor pursuing options to make this or similar newer-generation hormone therapy available to patients in SSA.
前列腺癌（CaP）是全球范围内癌症相关死亡的一个重要原因。低收入和中等收入国家（LMIC），尤其是撒哈拉以南非洲（SSA）的国家，面临着这种疾病不成比例的负担。与美国相比，潜在的遗传因素以及早期诊断和治疗的障碍导致SSA地区CaP患者的总体预后更差。在过去十年中，可用于CaP的治疗方法数量激增。讨论这些疗法可能对SSA地区转移性CaP患者当前管理产生的潜在影响，可能有助于确定使更多患者能够获得药物的目标的优先级。我们回顾了美国食品药品监督管理局（FDA）批准的转移性CaP治疗方法，同时承认鉴于药物获取障碍、所需的大量随访以及诊断和治疗所需的技术进步有限，这些治疗方案中的许多在SSA地区可能不可行。本手稿的目的是帮助那些可能不熟悉美国目前批准的CaP治疗方案的读者，提供可能有助于确定SSA地区这种癌症可用治疗方法优先级的信息。鉴于我们对SSA地区CaP治疗和美国现有治疗选择的回顾，阿比特龙在晚期CaP中已显示出显著益处，且耐受性良好。阿比特龙和泼尼松联合疗法在多项三期试验中已显示出对患者有显著的生存益处，并且由于它是新一代激素疗法中首个可用的药物，有通用版本可供选择，为患者提供了一种具有成本效益的选择。研究表明，与空腹服用全剂量相比，低剂量阿比特龙与低脂餐一起服用时具有相似的疗效，如果药物剂量较低，这可能会节省成本。总之，阿比特龙和泼尼松对SSA地区的患者可能具有临床意义，并且具有良好且易于管理的副作用特征。其他治疗选择也有显著益处；然而，阿比特龙的绝对益处以及给药的便利性将有利于寻求使这种或类似的新一代激素疗法可供SSA地区患者使用的选择。
