Androgen-targeted therapy in men with prostate cancer: evolving practice and future considerations.
Androgen-targeted therapy in men with prostate cancer: evolving practice and future considerations.
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DOI：
10.1038/s41391-018-0079-0
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发表时间：
2019-03
影响因子：
4.8
通讯作者：
Klotz L
中科院分区：
文献类型：
--
作者：
Crawford ED;Heidenreich A;Lawrentschuk N;Tombal B;Pompeo ACL;Mendoza-Valdes A;Miller K;Debruyne FMJ;Klotz L
雄激素剥夺疗法（ADT）是晚期前列腺癌（PCa）治疗的基础，并受益于最近的科学进步。这些包括批准抑制睾酮（T）水平或抑制其功能的新疗法，改进诊断和测定技术，确定T的较低治疗靶点，发现生殖系基因突变的相关性以及确定序贯和联合治疗的益处。本综述讨论了ADT的最新选择，管理晚期PCa患者的最佳实践和未来治疗方向的临床概况。现代分析技术显示，双侧睾丸切除术导致血清T水平约为15 ng/dL，而历史上阉割的定义为T < 50 ng/dL。有证据表明，将T水平降低至<20 ng/dL可改善患者生存率并延迟疾病进展。在整个治疗过程中，除了前列腺特异性抗原外，常规监测T对确保T抑制的持续有效性很重要。抑制雄激素信号传导的新药与传统ADT联合使用可将T活性抑制至接近零，并显著改善患者生存率。在个性化ADT方案时，医生应考虑多种因素，包括ADT的开始和持续时间，监测T水平和PSA，如果患者未达到充分的T抑制，则转换单药治疗的可能性，以及根据患者的生活方式，合并症，风险因素和治疗耐受性考虑间歇性还是连续性ADT。
Androgen deprivation therapy (ADT) is foundational in the management of advanced prostate cancer (PCa) and has benefitted from a recent explosion in scientific advances. These include approval of new therapies that suppress testosterone (T) levels or inactivate its function, improvements in diagnostic and assay technologies, identification of lower therapeutic targets for T, discovery of the relevance of germline genetic mutations and identification of the benefits of sequential and combination therapies. This review discusses the clinical profiles of the most up-to-date options for ADT, best practices for managing patients with advanced PCa and future directions in therapy. Modern assay technologies reveal that bilateral orchiectomy results in a serum T level of approximately 15 ng/dL as compared to the historical definition of castration of T < 50 ng/dL. Evidence shows that lowering T levels to <20 ng/dL improves patient survival and delays disease progression. Routine monitoring of T in addition to prostate-specific antigen throughout treatment is important to ensure continuing efficacy of T suppression. New drugs that inhibit androgen signaling in combination with traditional ADT suppress T activity to near zero and have significantly improved patient survival. When personalizing ADT regimens physicians should consider a number of factors including initiation and duration of ADT, monitoring of T levels and PSA, the possibility of switching monotherapies if a patient does not achieve adequate T suppression, and consideration of intermittent vs. continuous ADT according to patients’ lifestyles, comorbidities, risk factors and tolerance to treatment.
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影响因子：
3.8
作者：
Breul, Jurgen;Lundstrom, Eija;Goldfischer, Evan R.
通讯作者：
Goldfischer, Evan R.
影响因子：
23.4
作者：
Albertsen, Peter C.;Klotz, Laurence;Nilsson, Jan
通讯作者：
Nilsson, Jan
DOI：
10.1200/jco.2008.20.0642
发表时间：
2009-08-10
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Attard G;Reid AH;A'Hern R;Parker C;Oommen NB;Folkerd E;Messiou C;Molife LR;Maier G;Thompson E;Olmos D;Sinha R;Lee G;Dowsett M;Kaye SB;Dearnaley D;Kheoh T;Molina A;de Bono JS
通讯作者：
de Bono JS
DOI：
10.1056/nejmoa1405095
发表时间：
2014-07-31
期刊：
The New England journal of medicine
影响因子：
--
作者：
Beer TM;Armstrong AJ;Rathkopf DE;Loriot Y;Sternberg CN;Higano CS;Iversen P;Bhattacharya S;Carles J;Chowdhury S;Davis ID;de Bono JS;Evans CP;Fizazi K;Joshua AM;Kim CS;Kimura G;Mainwaring P;Mansbach H;Miller K;Noonberg SB;Perabo F;Phung D;Saad F;Scher HI;Taplin ME;Venner PM;Tombal B;PREVAIL Investigators
通讯作者：
PREVAIL Investigators
影响因子：
45.3
作者：
Chen, Dong-Yi;See, Lai-Chu;Huang, Wen-Kuan
通讯作者：
Huang, Wen-Kuan