Chemotherapy for prostate cancer
Chemotherapy for prostate cancer
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DOI：
10.1016/s0090-4295(02)01583-2
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发表时间：
2002-09-01
期刊：
影响因子：
2.1
通讯作者：
Kantoff, PW
中科院分区：
文献类型：
--
作者：
Gilligan, T;Kantoff, PW
雄激素剥夺治疗仍然是晚期前列腺癌患者和选定的局限性前列腺癌患者的主要治疗方法。雄激素剥夺疗法是这种疾病的靶向治疗模式。虽然很明显，需要开发其他靶向治疗，但细胞毒性化疗正在成为治疗前列腺癌男性的有效形式。早期的研究表明，联合米托蒽醌加皮质类固醇化疗可以给症状性难治性前列腺癌的男性，毒性最小，并可以提供显着的缓解。从那时起，人们已经认识到雌莫司汀，当与各种微管抑制剂组合时，在难治性前列腺癌中非常有效。雌莫司汀加紫杉烷的双胞胎似乎是最活跃的。虽然雌莫司汀似乎可以增加紫杉烷类的活性，但其活性机制尚不确定，其总体价值也受到类似的质疑，特别是鉴于其显著的毒性。正在探索省略雌莫司汀的方案（即，单独使用紫杉烷或紫杉烷加生物制剂）。此外，三联疗法（雌莫司汀+紫杉烷+第三种药物，如卡铂或依托泊苷）正在探索中。最后，在新辅助、辅助或血清学复发患者组的早期疾病背景下，开始探索化疗的效用。这些研究的数据才刚刚开始收集。
Androgen deprivation therapy remains the mainstay of therapy for patients with advanced prostate cancer and for selected patients with localized prostate cancer. Androgen deprivation therapy is the model of target-based therapies in this disease. Although it is clear that other target-based therapies need to be developed, cytotoxic chemotherapy is emerging as an effective form of treatment for men with prostate cancer. The early studies combining mitoxantrone plus a corticosteroid demonstrated that chemotherapy could be given to men with symptomatic hormone-refractory prostate cancer with minimal toxicity, and significant palliation could be provided. Since then, it has been recognized that estramustine, when combined with a variety of microtubular inhibitors, is very active in hormone-refractory prostate cancer. Doublets combining estramustine plus a taxane seem to be the most active. Although it appears that estramustine may add some activity to taxanes, the mechanism of its activity is uncertain, and its overall value is similarly questioned, particularly in light of its significant toxicity. Regimens that omit estramustine are being explored (ie, either taxane alone or taxane plus biologic agents). In addition, triplet therapy (combining estramustine plus a taxane plus a third drug, such as carboplatin or etoposide) is being explored. Finally, the utility of chemotherapy is beginning to be explored in the context of earlier disease in the neoadjuvant, adjuvant, or serologically relapsing group of patients. Data from these studies are just beginning to be gathered.