转移性割抵抗性前列腺癌的系统治疗选择:一个活生生的系统审查
Syed Arsalan Ahmed Naqvi1, Muhammad Umair Anjum1, Arifa Bibi2
1Division of Hematology and Oncology, Department of Medicine, Mayo Clinic, Phoenix, Arizona, United States.
概括
最佳的转移性割抵抗性前列腺癌 (mCRPC) 治疗取决于先前的治疗和同源重组修复 (HRR) 改变. 多 (ADP-ribose) 聚合酶抑制剂 (PARPi) 对BRCA突变的mCRPC有益,而其他疗法适合于HRR野生型患者.
科学领域:
- 在瘤学瘤学.
- 遗传学 是一个遗传学.
- 临床试验 临床试验
背景情况:
- 选择转移性割抵抗性前列腺癌 (mCRPC) 的最佳治疗方法是复杂的,因为护理标准不断变化.
- 之前的治疗方法在mCRPC管理中显著影响后续治疗选择.
研究的目的:
- 对mCRPC患者的全身疗法进行综合证据.
- 根据先前的治疗和同源重组修复 (HRR) 基因变异来分层治疗疗效.
- 为个性化mCRPC治疗提供临床实践指南.
主要方法:
- 在mCRPC中的随机临床试验 (RCT) 的活体系统性审查 (LSR).
- 使用活式搜索方法搜索了MEDLINE和EMBASE数据库.
- 包括143项与17523名患者的试验,评估无进展生存率 (PFS) 和总生存率 (OS).
主要成果:
- 聚 (ADP-ribose) 聚合酶抑制剂 (PARPi) 在BRCA突变的mCRPC中显示出益处,特别是在之前的雄激素剥夺疗法 (ADT) 和/或雄激素受体通路抑制剂 (ARPI) 中.
- PARPi可能有利于选择非BRCA HRR变化 (例如CDK12,PALB2).
- 在没有HRR变化的患者中,阿比拉,恩扎胺,卡巴西塔克塞尔,多塞塔克塞尔和卢-177 (Lu177) 显示出益处.
结论:
- 最佳的mCRPC治疗需要根据先前的治疗和HRR变化进行个性化.
- 对于BRCA突变的mCRPC来说,PARPi是最受欢迎的,单独或与ARPI结合.
- 对于没有HRR变化的患者,ARPI,化疗和Lu177仍然是可行的选择.
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