Current Systemic Therapy in Men with Metastatic Castration-Sensitive Prostate Cancer

IF 4.7 2区 医学 Q1 ONCOLOGY
Guillaume Grisay, Pernelle Lavaud, Karim Fizazi
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引用次数: 0

Abstract

Purpose of Review

This review aims to explore the evolving landscape of treatments available for metastatic castration-sensitive prostate cancer (mCSPC) patients.

Recent Findings

In less than a decade, evidence was chronologically provided that (1) systemic treatment intensification with docetaxel improves outcomes, including survival, in men with mCSPC, (2) then that these outcomes are also improved when a second-generation androgen receptor pathway inhibitor (ARPI) is combined with androgen deprivation therapy (ADT), and (3) using a “triplet systemic therapy,” which consists in the combination of ADT, an ARPI and docetaxel, further improves outcomes, including survival. Radiotherapy to the prostate combined with ADT alone is now recommended in men with low-volume mCSPC. Combining prostate radiotherapy and intensified systemic treatment including abiraterone may be synergistic as suggested in the PEACE-1 trial. Also, the role of metastases-directed local therapies (mostly stereotactic radiotherapy) is currently being assessed in phase 3 trials. Finally, the integration of biomarkers (e.g. BRCA2 gene alterations, PTEN loss, PSMA expression) for decision making is not currently established, though trials are also currently underway. Importantly, most evidence currently available was obtained in men with de novo metastases, while for those with metastatic relapse after definitive local treatment, the role of treatment intensification is less well established.

Summary

Treatment intensification is nowadays the standard of care for patients with de novo mCSPC as it leads to outcomes improvement, including survival, and the standard of care is evolving almost on a yearly basis.

转移性钙化敏感性前列腺癌患者的现有系统疗法
综述目的本综述旨在探讨转移性阉割敏感性前列腺癌(mCSPC)患者现有治疗方法的演变情况。最新研究结果在不到十年的时间里,按时间顺序提供的证据表明:(1) 多西他赛的全身强化治疗可改善mCSPC男性患者的预后,包括生存期;(2) 第二代雄激素受体通路抑制剂(ARPI)与雄激素剥夺疗法(ADT)联合使用也可改善预后;(3) 使用 "三联全身疗法"(即ADT、ARPI和多西他赛联合使用)可进一步改善预后,包括生存期。目前,对于患有低体积 mCSPC 的男性,推荐采用前列腺放疗联合 ADT 单独治疗。根据 PEACE-1 试验的建议,前列腺放疗与包括阿比特龙在内的强化系统治疗相结合可能会产生协同作用。此外,转移灶定向局部疗法(主要是立体定向放疗)的作用目前正在三期试验中进行评估。最后,虽然目前正在进行相关试验,但将生物标志物(如 BRCA2 基因改变、PTEN 缺失、PSMA 表达)用于决策的做法尚未确立。重要的是,现有的大多数证据都是针对新发转移的男性患者的,而对于经过明确的局部治疗后转移复发的患者,强化治疗的作用还没有得到很好的证实。小结强化治疗是当今新发 mCSPC 患者的标准治疗方法,因为它能改善患者的预后,包括生存率,而且治疗标准几乎每年都在发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.50
自引率
0.00%
发文量
187
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published clinical findings in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by cancer. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as cancer prevention, leukemia, melanoma, neuro-oncology, and palliative medicine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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