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Patienten mit metastasiertem Prostatakarzinom

Empfehlungen zur primären Hormon- oder Hormonchemotherapie

Patients with metastatic prostate cancer

Recommendations for primary hormonal or chemohormonal therapy

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Zusammenfassung

Die bisherige Standardtherapie beim metastasierten kastrationssensitiven Prostatakarzinom (mCRPC) bestand in der Androgendeprivation (ADT), entweder mittels einer LHRH-Monotherapie („luteinizing hormone releasing hormone“) oder in Kombination mit einem Antiandrogen. Jedoch konnten unlängst zwei Phase-III-Studien (CHAARTED bzw. STAMPEDE) einen beträchtlichen Überlebensvorteil (14 bzw. 22 Monate) zugunsten der Kombination aus ADT plus Docetaxel-basierter Chemotherapie zeigen, welche in den aktuellen Leitlinien der European Association of Urology (EAU) und Deutschen Gesellschaft für Urologie (DGU) empfohlen wird. Dabei scheinen anhand der Ergebnisse der CHAARTED-Studie v. a. Patienten mit einer hohen Metastasenlast besonders von der Hormonchemotherapie zu profitieren. Mit den Ergebnissen der LATITUDE-Studie und weiteren Studienarmen der STAMPEDE-Studie steht mit der Kombination aus ADT plus Abirateron/Prednison seit kurzem eine Alternative zur Hormonchemotherapie zur Verfügung. Diese Kombination führt zu einem identischen Überlebensvorteil wie die Hormonchemotherapie und wird gleichwertig von Fachgremien (Arbeitskreis Onkologie [AKO], Arbeitsgemeinschaft Urologische Onkologie [AUO]) empfohlen. Derzeit kann anhand der Daten nicht beurteilt werden, welcher Patient von der Hormonchemotherapie und wer von der Kombination aus ADT + Abirateron/Prednison profitiert.

Abstract

The standard treatment for patients with metastatic, hormone-sensitive prostate cancer (mCSPC) has so far consisted of medical or surgical castration. However, two published clinical trials using docetaxel in combination with castration (CHAARTED and STAMPEDE) recently provided evidence for a substantial improvement in overall survival. The survival benefit was 14 and 22 months, respectively, in the two trials. In addition, the CHAARTED trial showed that patients with high-volume disease may benefit most from chemohormonal treatment. According to the current available evidence, the new standard of treatment for patients therefore consists of castration in combination with docetaxel-based chemotherapy, which should be offered to all patients who are fit to receive chemotherapy. With the results of the LATITUDE and a further study-arm of the STAMPEDE trial, the combination of androgen-deprivation therapy (ADT) plus abiraterone/prednisone has recently become an alternative treatment to chemohormonal treatment. This combination leads to an identical survival benefit compared to chemohormonal treatment and is recommended by expert panels. Based on the current evidence, it is not possible to decide which patient may benefit from chemohormonal treatment and who will benefit from the combination of ADT plus abiraterone/prednisone.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universität des Saarlandes, Kirrbergerstr., 66421, Homburg/Saar, Deutschland

    C.-H. Ohlmann

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Correspondence to C.-H. Ohlmann.

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C.-H. Ohlmann war in beratender Funktion für Janssen-Cilag und Sanofi tätig und hat von diesen Honorare erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Ohlmann, CH. Patienten mit metastasiertem Prostatakarzinom. Urologe 56, 1424–1429 (2017). https://doi.org/10.1007/s00120-017-0517-y

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