Optimizing Anticancer Therapy in Metastatic Non-Castrate Prostate Cancer: American Society of Clinical Oncology Clinical Practice Guideline
Optimizing Anticancer Therapy in Metastatic Non-Castrate Prostate Cancer: American Society of Clinical Oncology Clinical Practice Guideline
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DOI：
10.1200/jco.2018.78.0619
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发表时间：
2018-05-20
影响因子：
45.3
通讯作者：
Milowsky, Matthew I.
中科院分区：
文献类型：
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作者：
Morris, Michael J.;Rumble, R. Bryan;Milowsky, Matthew I.
PurposeThis临床实践指南地址阿比特龙或多西他赛与雄激素剥夺治疗（ADT）的转移性前列腺癌，还没有治疗（或已最低限度地治疗）与testosterone-lowering agents.MethodsStandard治疗新诊断的转移性前列腺癌一直是ADT。三项研究比较了ADT单独与ADT和多西他赛，和两项研究比较了ADT单独与ADT和abiraterone.ResultsThree前瞻性随机研究（GETUG-AFU 15，STAMPEDE，CHAARTED）检查总生存期（OS）与多西他赛加入ADT。STAMPEDE和CHAARTED支持多西他赛（风险比[HR]，0. 78; 95% CI，0. 66 - 0. 93; n = 2，962; HR，0. 73; 95% CI，0. 59 - 0. 89; n = 790）。GETUG-AFU 15为阴性。LATITUDE和STAMPEDE检查了ADT基础上添加阿比特龙（联合泼尼松或泼尼松龙）对OS的影响。LATITUDE和STAMPEDE支持阿比特龙（HR，0.62; 95%CI，0.51 - 0.76; n = 1，199和HR，0.63; 95%CI，0.52 - 0.76; n = 1，917）。推荐ADT联合多西他赛或阿比特龙治疗新诊断的转移性非去势前列腺癌与ADT单药治疗相比，可提供生存获益。多西他赛获益的最强证据是在新发高容量（CHAARTED标准）转移性疾病男性中。在高风险患者（LATITUDE标准）和STAMPEDE的转移性人群中观察到醋酸阿比特龙的相似生存获益。ADT+阿比特龙和ADT+多西他赛尚未进行比较，也不知道是否有些男性从一种方案中获益更多。化疗的适应性、患者合并症、毒性特征、生活质量、药物可用性和成本应在此决定中考虑。更多信息请访问www.asco.org/genitourinary-cancer-guidelines。
PurposeThis clinical practice guideline addresses abiraterone or docetaxel with androgen-deprivation therapy (ADT) for metastatic prostate cancer that has not been treated (or has been minimally treated) with testosterone-lowering agents.MethodsStandard therapy for newly diagnosed metastatic prostate cancer has been ADT alone. Three studies have compared ADT alone with ADT and docetaxel, and two studies have compared ADT alone with ADT and abiraterone.ResultsThree prospective randomized studies (GETUG-AFU 15, STAMPEDE, and CHAARTED) examined overall survival (OS) with adding docetaxel to ADT. STAMPEDE and CHAARTED favored docetaxel (hazard ratio [HR], 0.78; 95% CI, 0.66 to 0.93; n = 2,962 and HR, 0.73; 95% CI, 0.59 to 0.89; n = 790, respectively). GETUG-AFU 15 was negative. LATITUDE and STAMPEDE examined the impact on OS of adding abiraterone (with prednisone or prednisolone) to ADT. LATITUDE and STAMPEDE favored abiraterone (HR, 0.62; 95% CI, 0.51 to 0.76; n = 1,199 and HR, 0.63; 95% CI, 0.52 to 0.76; n = 1,917, respectively).RecommendationsADT plus docetaxel or abiraterone in newly diagnosed metastatic non-castrate prostate cancer offers a survival benefit as compared with ADT alone. The strongest evidence of benefit with docetaxel is in men with de novo high-volume (CHAARTED criteria) metastatic disease. Similar survival benefits are seen using abiraterone acetate in high-risk patients (LATITUDE criteria) and in the metastatic population in STAMPEDE. ADT plus abiraterone and ADT plus docetaxel have not been compared, and it is not known if some men benefit more from one regimen as opposed to the other. Fitness for chemotherapy, patient comorbidities, toxicity profiles, quality of life, drug availability, and cost should be considered in this decision. Additional information is available at www.asco.org/genitourinary-cancer-guidelines.