Zusammenfassung
Aktuell stellen neuartige Kombinationstherapien den Standard in der Therapie des metastasierten hormonsensitiven Prostatakarzinoms dar. Hierdurch kann das Gesamtüberleben der Patienten um etwa 1,5 Jahre verlängert werden. Als Kombinationspartner zur klassischen Androgendeprivation können aktuell das Taxan Docetaxel, der CYP17-Inhibitor Abirateron und das Zweitgenerationsantiandrogen Apalutamid eingesetzt werden. Während die De-novo-Synthese von Testosteron die Rationale für die Kombination mit Abirateron oder Apalutamid darstellt, bieten Taxane einen vielversprechenden Ansatz bei anteiligem Vorliegen von primär androgenunabhängigen Prostatakarzinomzellen. Aufgrund der durch Kombinationstherapie erhöhten Nebenwirkungsrate gilt es für den klinischen Alltag zu klären, welche Patientengruppe insbesondere von der jeweiligen Kombinationstherapie profitiert. Hierbei spielen u. a. das Metastasierungsmuster, der Allgemeinzustand sowie das Alter eine wichtige Rolle. Während bei viszeraler Metastasierung eine gute Evidenz für den Einsatz von Docetaxel oder Abirateron vorliegt, bietet Apalutamid ein sehr breites Einsatzspektrum. Letztendlich ist die Empfehlung zur Kombinationstherapie immer eine individuelle Entscheidung, die mit dem Patienten unter Abwägung von Nutzen und Risiko besprochen werden muss.
Abstract
Novel combination therapies are currently the standard systemic treatment for metastatic hormone-sensitive prostate cancer. As a result, the overall survival of patients can be extended by approximately 1.5 years. The taxane docetaxel, the CYP17 inhibitor abiraterone and the second generation antiandrogen apalutamide can currently be used as a combination partner for classic androgen deprivation. While the de novo synthesis of testosterone is the rationale for abiraterone or apalutamide combination, taxanes offer a promising approach in the presence of primarily androgen-independent prostate cancer cells. Due to the increased rate of side effects caused by combination therapy, it is important to clarify in daily clinical practice which patient group benefits in particular from the respective combination therapy. Hereby, the metastatic pattern, general condition and age play an important role. While there is good evidence of the use of docetaxel or abiraterone in visceral metastasis, apalutamide offers a very wide range of uses. Ultimately, the recommendation for combination therapy is always an individual decision that needs to be discussed with the patient, considering the benefits and risks.
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C. Thomas: Vortragstätigkeit: Janssen, Astellas, Sanofi; Beratende Tätigkeit: Janssen, Astellas. C.-H. Ohlmann: Vortragstätigkeit: Janssen; Beratende Tätigkeit: Janssen, Sanofi, Astellas.
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Thomas, C., Ohlmann, C. Kombinierte Systemtherapie beim metastasierten hormonsensitiven Prostatakarzinom: Was? Wann? Bei wem?. Urologe 59, 665–672 (2020). https://doi.org/10.1007/s00120-020-01189-7
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DOI: https://doi.org/10.1007/s00120-020-01189-7