[Treatment of metastatic, castration-resistant prostate cancer].
Therapie des metastasierten kastrationsresistenten Prostatakarzinoms.
Abiraterone
Cabazitaxel
Docetaxel
Enzalutamide
Radium-223
Journal
Der Urologe. Ausg. A
ISSN: 1433-0563
Titre abrégé: Urologe A
Pays: Germany
ID NLM: 1304110
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
pubmed:
11
4
2020
medline:
2
7
2020
entrez:
11
4
2020
Statut:
ppublish
Résumé
For many decades metastatic, castration-resistant prostate cancer (mCRPC) was thought to be treatment inaccessible. However, today, five drugs with significant life-prolonging effects are available in Germany, namely abiraterone, enzalutamide, docetaxel, cabazitaxel and radium-223. The different treatment strategies in mCRPC are reviewed. Landmark trials with supplementary information from Medline and abstracts of international congresses (ASCO; ASCO GU, ESMO) are summarized. The androgen receptor (AR)-targeting agents abiraterone and enzalutamide significantly prolong overall survival before and after docetaxel therapy. In addition, cabazitaxel can be applied secondary to docetaxel. Due to the low affinity of cabazitaxel to p‑glycoprotein it remains active even if docetaxel has failed. The α‑emitter radium-223 can be considered in third line therapy for symptomatic patients with bone limited disease only. In patients with castration resistance, a short prostate-specific antigen (PSA) doubling time but without metastases in conventional imaging apalutamide, darolutamide and enzalutamide significantly prolong metastasis-free survival. Prostate-specific membrane antigen (PSMA)-ligand therapy and novel targeting agents such as PARP inhibitors are promising new therapeutic modalities for mCRPC. Combination treatment strategies with immunotherapy are currently being evaluated in clinical trials. Based on the results of molecular analyses of tumor tissue as well as of circulating tumor cells and DNA, treatment of prostate cancer will be increasingly personalized in the future.
Sections du résumé
BACKGROUND
BACKGROUND
For many decades metastatic, castration-resistant prostate cancer (mCRPC) was thought to be treatment inaccessible. However, today, five drugs with significant life-prolonging effects are available in Germany, namely abiraterone, enzalutamide, docetaxel, cabazitaxel and radium-223.
OBJECTIVE
OBJECTIVE
The different treatment strategies in mCRPC are reviewed.
MATERIALS AND METHODS
METHODS
Landmark trials with supplementary information from Medline and abstracts of international congresses (ASCO; ASCO GU, ESMO) are summarized.
RESULTS
RESULTS
The androgen receptor (AR)-targeting agents abiraterone and enzalutamide significantly prolong overall survival before and after docetaxel therapy. In addition, cabazitaxel can be applied secondary to docetaxel. Due to the low affinity of cabazitaxel to p‑glycoprotein it remains active even if docetaxel has failed. The α‑emitter radium-223 can be considered in third line therapy for symptomatic patients with bone limited disease only. In patients with castration resistance, a short prostate-specific antigen (PSA) doubling time but without metastases in conventional imaging apalutamide, darolutamide and enzalutamide significantly prolong metastasis-free survival.
DISCUSSION
CONCLUSIONS
Prostate-specific membrane antigen (PSMA)-ligand therapy and novel targeting agents such as PARP inhibitors are promising new therapeutic modalities for mCRPC. Combination treatment strategies with immunotherapy are currently being evaluated in clinical trials. Based on the results of molecular analyses of tumor tissue as well as of circulating tumor cells and DNA, treatment of prostate cancer will be increasingly personalized in the future.
Identifiants
pubmed: 32274540
doi: 10.1007/s00120-020-01187-9
pii: 10.1007/s00120-020-01187-9
doi:
Substances chimiques
Androgen Antagonists
0
Antineoplastic Agents
0
Docetaxel
15H5577CQD
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM