Oh W K, Kantoff P W
Lank Center for Genitourinary Oncology, Department of Adult Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Urol. 1998 Oct;160(4):1220-9.
Recent advances in the biology and treatment of hormone refractory prostate cancer are reviewed.
A MEDLINE literature search of secondary hormonal therapy and chemotherapy for hormone refractory prostate cancer was performed. Recent advances in the biology of hormone refractory prostate cancer, changes in the measurement of response to therapy, and testing of new drugs and combinations of drugs were reviewed.
Historically the treatment of hormone refractory prostate cancer has been disappointing. Useful parameters to monitor clinical response have been lacking but perhaps more importantly a scarcity of apparently active drugs has contributed to these results. Recently several developments have improved the outlook for treatment of hormone refractory prostate cancer. Recognition of antiandrogen withdrawal responses has had important ramifications for clinical trial interpretation and patient care. Secondary hormonal therapies, such as alternative antiandrogens and anti-adrenal agents, are well tolerated and can provide significant clinical benefits. Combining prostate specific antigen values with quality of life and measurable disease responses has made clinical trial end points more objective and more clinically relevant for the patient. Furthermore, a better understanding of the biology of hormone refractory prostate cancer, refinements in measuring response to treatment and availability of agents with proved palliative capabilities and/or generating greater than 50% response have all lead to improvements in treatment management. In 2 randomized studies mitoxantrone in combination with steroids has demonstrated significant palliative benefit compared with steroids alone. In phase II studies more than half of patients respond to estramustine combinations with vinblastine, etoposide or paclitaxel. Other novel combinations and new drugs currently are being tested.
Recent advances suggest that available therapies for hormone refractory prostate cancer can have a meaningful impact on the disease. Improving treatment of hormone refractory prostate cancer remains an area of active investigation.
综述激素难治性前列腺癌生物学及治疗方面的最新进展。
通过MEDLINE文献检索激素难治性前列腺癌的二线激素治疗及化疗情况。综述激素难治性前列腺癌生物学的最新进展、治疗反应评估方法的变化以及新药和联合用药的试验情况。
从历史上看，激素难治性前列腺癌的治疗效果令人失望。一直缺乏监测临床反应的有用参数，但或许更重要的是，明显有效的药物匮乏导致了这样的结果。最近有几项进展改善了激素难治性前列腺癌的治疗前景。对抗雄激素撤药反应的认识对临床试验解读和患者护理产生了重要影响。二线激素治疗，如替代抗雄激素药物和抗肾上腺药物，耐受性良好，能带来显著的临床益处。将前列腺特异性抗原值与生活质量及可测量的疾病反应相结合，使临床试验终点更客观，对患者更具临床相关性。此外，对激素难治性前列腺癌生物学的更好理解、治疗反应测量方法的改进以及具有已证实的姑息治疗能力和/或产生超过50%反应的药物的可用性，都导致了治疗管理的改善。在两项随机研究中，米托蒽醌联合类固醇与单独使用类固醇相比，已显示出显著的姑息治疗益处。在II期研究中，超过一半的患者对雌莫司汀与长春碱、依托泊苷或紫杉醇的联合用药有反应。目前正在测试其他新型联合用药和新药。
最新进展表明，现有的激素难治性前列腺癌治疗方法可对该疾病产生有意义的影响。改善激素难治性前列腺癌的治疗仍是一个积极研究的领域。
