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Medikamentöse Therapie des hormonsensitiven metastasierten Prostatakarzinoms

Konsensuspapier AKO/AUO

Drug therapy of hormone-sensitive metastatic prostate cancer

Consensus paper of the AKO/AUO

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Zusammenfassung

Hintergrund

Die bisherige Standardtherapie beim metastasierten, hormonsensitiven Prostatakarzinom (mHSPC) bestand in der Androgendeprivation, entweder mittels einer LHRH-Monotherapie („luteinizing hormone releasing hormone“) oder in Kombination mit einem Antiandrogen. Eine zusätzliche zytotoxische Chemotherapie konnte in verschiedenen Studien und mit unterschiedlichen Schemata keinen zusätzlichen Überlebensvorteil zeigen.

Ergebnisse

Nach einer ersten ebenfalls negativen Studie mit einer Docetaxel-basierten Chemotherapie konnten unlängst jedoch 2 große Phase-III-Studien (CHAARTED bzw. STAMPEDE) einen beträchtlichen Überlebensvorteil zugunsten der Hormonchemotherapie zeigen. Dabei findet sich im Gesamtergebnis ein Überlebensvorteil von ca. 14 bzw. 22 Monaten. Darüber hinaus scheinen anhand der Ergebnisse der CHAARTED-Studie v. a. Patienten mit einer hohen Metastasenlast besonders von der Hormonchemotherapie zu profitieren.

Schlussfolgerung

Der neue Therapiestandard von Patienten mit einem mHSPC besteht daher in der Kombination der Androgendeprivation mit einer Docetaxel-basierten Chemotherapie. Diese Therapie sollte allen Patienten, die für eine Chemotherapie geeignet sind, angeboten werden.

Abstract

Background

The standard treatment of patients with metastatic, hormone-sensitive prostate cancer (mCSPC) currently consists of medical or surgical castration. The addition of a cytotoxic chemotherapy was unable to provide a survival benefit over castration alone in several clinical trials using different chemotherapy regimens.

Results

Even a preliminary clinical trial using a docetaxel-based chemohormonal combination did not show a survival benefit. In contrast, two more recently published clinical trials (CHAARTED and STAMPEDE) using docetaxel in combination with castration provided evidence for a substantial improvement in overall survival. The survival benefit was 14 and 22 months in the two trials. In addition, the CHAARTED trial showed that patients with high volume disease may benefit most from chemohormonal treatment.

Conclusion

According to the current available evidence, the new standard of treatment for patients therefore consists of castration in combination with docetaxel-based chemotherapy and should be offered to all patients who are fit to receive chemotherapy.

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Literatur

  1. DKG/AWMF (2014) Interdisziplinäre Leitlinie der Qualität S3zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms

  2. Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 65:467–479

    Article  CAS  PubMed  Google Scholar 

  3. Pagliarulo V, Bracarda S, Eisenberger MA et al (2012) Contemporary role of androgen deprivation therapy for prostate cancer. Eur Urol 61:11–25

    Article  CAS  PubMed  Google Scholar 

  4. Hussain M, Tangen CM, Berry DL et al (2013) Intermittent versus continuous androgen deprivation in prostate cancer. N Engl J Med 368:1314–1325

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. James ND, Spears MR, Clarke NW et al (2015) Survival with newly diagnosed metastatic prostate cancer in the “Docetaxel era”: data from 917 patients in the control arm of the STAMPEDE Trial (MRC PR08, CRUK/06/019). Eur Urol 67:1028–1038

    Article  PubMed  Google Scholar 

  6. Millikan RE, Wen S, Pagliaro LC et al (2008) Phase III trial of androgen ablation with or without three cycles of systemic chemotherapy for advanced prostate cancer. J Clin Oncol 26:5936–5942

    Article  PubMed  PubMed Central  Google Scholar 

  7. Noguchi M, Noda S, Yoshida M et al (2004) Chemohormonal therapy as primary treatment for metastatic prostate cancer: a randomized study of estramustine phosphate plus luteinizing hormone-releasing hormone agonist versus flutamide plus luteinizing hormone-releasing hormone agonist. Int J Urol 11:103–109

    Article  CAS  PubMed  Google Scholar 

  8. Hoshi S, Yamaguchi O, Fujioka T et al (2006) A randomized comparative study of endocrine monotherapy and a combination of estramustine phosphate with the endocrine therapy in patients with untreated stage D prostate cancer. Int J Clin Oncol 11:303–308

    Article  CAS  PubMed  Google Scholar 

  9. Gravis G, Fizazi K, Joly F et al (2013) Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): a randomised, open-label, phase 3 trial. Lancet Oncol 14:149–158

    Article  CAS  PubMed  Google Scholar 

  10. Gravis G, Boher JM, Joly F et al (2015) Androgen Deprivation Therapy (ADT) plus Docetaxel versus ADT alone in metastatic non castrate prostate cancer: impact of metastatic burden and long-term survival analysis of the randomized phase 3 GETUG-AFU15 trial. Eur Urol. doi:10.1016/j.eururo.2015.11.005

    Google Scholar 

  11. Sweeney C, Chen Y, Carducci MA et al (2014) Impact on overall survival (OS) with chemohormonal therapy versus hormonal therapy for hormone-sensitive newly metastatic prostate cancer (mPrCa): An ECOG-led phase III randomized trial. J Clin Oncol 32(5s):LBA2

    Google Scholar 

  12. Sweeney CJ, Chen YH, Carducci M et al (2015) Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. doi:10.1056/nejmoa1503747

    PubMed  PubMed Central  Google Scholar 

  13. Patrick-Miller LJ et al (2016) Quality of life (QOL) analysis from CHAARTED: Chemohormonal androgen ablation randomized trial in prostate cancer (E3805). J Clin Oncol 34(Suppl):abstr 5004

  14. James ND, Sydes MR, Mason M et al (2015) Docetaxel and/or zoledronic acid for hormone-naïve prostate cancer: First overall survival results from STAMPEDE (NCT00268476). J Clin Oncol 33:5001

    Google Scholar 

  15. Tannock IF, Amir E (2015) Clinical trial design and chemotherapy use in prostate cancer: correcting old mistakes, making new ones. discussant of abstr. 5001. In: ASCO Annual Meeting. J Clin Oncol, Chicago

    Google Scholar 

  16. Tucci M, Bertaglia V, Vignani F et al (2016) Addition of Docetaxel to androgen deprivation therapy for patients with hormone-sensitive metastatic prostate cancer: A systematic review and meta-analysis. Eur Urol 69:563–573

    Article  CAS  PubMed  Google Scholar 

  17. Vale CL, Burdett S, Rydzewska LH et al (2016) Addition of docetaxel or bisphosphonates to standard of care in men with localised or metastatic, hormone-sensitive prostate cancer: a systematic review and meta-analyses of aggregate data. Lancet Oncol 17:243–256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Ramos-Esquivel A, Fernández C, Zeledón Z (2016) Androgen-deprivation therapy plus chemotherapy in metastatic hormone-sensitive prostate cancer. A systematic review and meta-analysis of randomized clinical trials. Urol Oncol. doi:10.1016/j.urolonc.2016.03.003

    PubMed  Google Scholar 

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Authors and Affiliations

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

    C.-H. Ohlmann

  2. Klinik und Poliklinik für Urologie, der Technischen Universität München, Klinikum rechts der Isar, München, Deutschland

    J. Gschwend

  3. Klinik für Urologie, Charité, Berlin, Deutschland

    K. Miller

Authors
  1. C.-H. Ohlmann
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  2. J. Gschwend
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  3. K. Miller
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Correspondence to C.-H. Ohlmann.

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Interessenkonflikt

C.-H. Ohlmann gibt folgenden Interessenskonflikt an: Beratertätigkeit, Vortragshonorare mit Sanofi-Aventis Deutschland GmbH. J. Gschwend, K. Miller, Mitglieder von AKO und Vorstandsmitglieder der AUO geben an, dass kein Interessenkonflikt besteht.

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

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Dieser Beitrag entstand als Konsensuspapier im Namen der Mitglieder der AKO und der Vorstandsmitglieder der AUO.

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Ohlmann, CH., Gschwend, J. & Miller, K. Medikamentöse Therapie des hormonsensitiven metastasierten Prostatakarzinoms. Urologe 55, 1164–1172 (2016). https://doi.org/10.1007/s00120-016-0178-2

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