Strategy in advanced castration-resistant prostate cancer

被引:0
|
作者
Gross-Goupil, Marine [1 ,2 ]
Roca, Sophie [1 ]
Pasticier, Gilles [3 ]
Ravaud, Alain [1 ,2 ]
机构
[1] CHU Bordeaux, Hop St Andre, Med Oncol Serv, F-33075 Bordeaux, France
[2] Univ Bordeaux 2, F-33076 Bordeaux, France
[3] CHU Bordeaux, Hop Pellegrin, Serv Urol, F-33075 Bordeaux, France
关键词
prostate cancer; hormonotherapy; chemotherapy; immunotherapy; targeted therapy; MITOXANTRONE PLUS PREDNISONE; PHASE-III TRIAL; SIPULEUCEL-T; ANTIANDROGEN WITHDRAWAL; 2ND-LINE CHEMOTHERAPY; DOCETAXEL; ESTRAMUSTINE; EFFICACY; ABIRATERONE; SURVIVAL;
D O I
10.1684/bdc.2012.1562
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
If androgen deprivation, chemical with [H-RH analogs or surgical with bilateral orchiectomy, still remains the stone edge of treatment of prostate cancer, in the metastatic setting, this hormonosensitivity, most of the time long, finally move on in hormonal-failure. If rare changes in the therapeutic strategy have been achieved in this setting since 2004 and the arrival of docetaxel, it is the global perception of the disease that has been modified and the definition of one specific entity: the castrate-resistant prostate cancer. This new definition and the changes of design and end-points of clinical trials testing new agents with strong recruitment during the past years have conducted to a real revolution in the management of castrate-refractory prostate cancer. The place of secondary hormonal manipulations, such as withdrawal of the anti-androgen, oestrogen or ketoconazole, still exists for a selected group of patients. In case of aggressive disease and symptoms, chemotherapy should be selected, docetaxel, in a three weeks schedule, and may be combined with Estracyt. It is time to consider the revolution of the post-chemotherapy setting with the arrival of two new drugs; a cytotoxic one, the cabazitaxel and hormonal for the second one, the abiraterone acetate. The place of the immunotherapy with the sipuleucel-T may be more difficult to precise, especially in Europe, even if it has been finally indicated in the United States in the metastatic setting. Concerning bone metastasis, zoledronic acid was during a long time the only bone-targeted agent, effective in reducing the incidence of skeletal related events, and was recently exceeded by the denosumab, an anti-RANK ligand. Finally, let us hope that other changes will be achieved in the near future, with the cabazitaxel-docetaxel confrontation in the first-line setting, and the introduction of the abiraterone acetate before chemotherapy with docetaxel, already tested in ongoing trials.
引用
收藏
页码:S37 / S45
页数:9
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