在化敏感前列腺癌中使用新型荷尔蒙疗法加强治疗:患者鉴定和临床理由
Cora N Sternberg1, Stephen J Freedland2, Daniel J George3
1Clinical Director, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY; Department of Medicine, Sandra and Edward Meyer Cancer Center, New York-Presbyterian, New York, NY.
新型荷尔蒙疗法 (NHT) 改善了转移性割敏感前列腺癌 (mCSPC) 的存活率. 由于各种障碍,利用不足仍然存在,因此需要制定加强治疗强化策略,以获得更好的患者结果.
科学领域:
- 在瘤学瘤学.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 医学科学 医学科学 医学科学
背景情况:
- 化敏感前列腺癌 (CSPC) 治疗指南建议使用新型荷尔蒙疗法 (NHT) 或雄激素受体通路抑制剂.
- 一级临床证据支持在转移性CSPC (mCSPC) 中使用NHT加强雄激素剥夺疗法 (ADT),改善生存率和生活质量.
研究的目的:
- 审查在CSPC中使用NHT的临床理由.
- 为了确定NHT在mCSPC中未充分利用的原因,尽管已证明有好处.
- 讨论CSPC中生化复发的治疗策略.
主要方法:
- 进行了PubMed搜索,以确定有关CSPC治疗NHT的相关出版物.
- 对临床试验数据和关于mCSPC中NHT利用的现实世界的证据的审查.
- 分析导致治疗强化不充分使用的因素.
主要成果:
- 一级证据证实,NHT可以延长生命并改善mCSPC患者的生活质量.
- 现实世界的数据表明,NHTs的使用不足显著,mCSPC患者中有47%-88%仅接受单剂ADT.
- 阻碍NHT使用的障碍包括患者因素,意识差距,医生偏见,安全问题和访问问题.
结论:
- 解决NHT访问和意识的障碍对于改善mCSPC的结果至关重要.
- 使用临床病理学特征,基因组学和高级成像指南的风险分层对生物化学复发的治疗.
- 早期启动NHT,正如EMBARK试验对高风险生化复发的建议,以及生活方式管理对于优化患者护理至关重要.
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