U kojih bolesnika primijeniti hormonsku terapiju + docetaksel

Autor: Gamulin, Marija, Bebek, Marko, Gnjidic, Milena
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Acta clinica Croatica
Volume 58.
Issue Supplement 2
Acta Clinica Croatica
ISSN: 1333-9451
0353-9466
Popis: Docetaxel improved the outcome of patients with mCSPC and became standard of care after CHAARTED , STAMPEDE arm C and GET UG-AFU 15 clinical trials and after subsequent meta-analysis. Patients with high-volume (CHAARTED definition) and high-risk (LATITUDE definition) disease, who have good performance status and are fit for chemotherapy, seem to benefit the most from addition of docetaxel to the androgen deprivation therapy. Results from TITAN trial with apalutamide showed the activity in the same setting. However, predictive biomarkers are still lacking. We have direct evidence of overall survival benefit from abiraterone, apalutamide and enzalutamide for patients with high-volume disease who are not fit for chemotherapy, as well as for patients with low-volume disease. Clinical trials will show is there place for triple therapy in clinical practice. Before obtaining the results of new clinical trial results, physicians should base their treatment decision on risks and benefits of each current approach and consider the patient´s other health issues such as access, costs, patient and patient´s preferences.
Uvođenje kemoterapije docetakselom je dovelo do unaprijeđenja ishoda liječenja u bolesnika s metastatskim senzitivnim rakom prostate te je dodatak docetaksela postao standard liječenja što je temeljeno na rezultatima studija CHAARTED, STAMPEDE, grane C i GET UG-AFU 15 studiji te nakon toga učinjene meta analize. Bolesnici s visokim volumenom bolesti (definicija po CHAARTED studiji) i visokog rizika (definicija prema LATIT UTDE studiji), koji imaju dobar performance status i koji su pogodni za kemoterapiju, imaju najviše koristi od dodatka docetaksela androgenoj deprivacijskoj terapiji. Rezultati TITAN studije su pokazali aktivnosti apalutamida u istoj indikaciji. Ipak, prediktivni biomarkeri još uvijek nedostaju. Postoje jasni dokazi o koristi u ukupnom preživljenju od abiraterona, apalutamida i enzalutamida u bolesnika s bolesti visokog volumena koji nisu pogodni za kemoterapiju, kao i za bolesnike s bolesti niskog volumena. Kliničke studije će pokazati mjesto za trostruku terapiju u kliničkoj praksi. Prije objave rezultata novih kliničkih studija, liječnici trebaju temeljiti svoje odluke na temelju procjene rizika i koristi svakog trenutnog pristupa i razmotriti druge parametre poput troškova liječenja, dostupnosti skrbi te preferencije bolesnika.
Databáze: OpenAIRE
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