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Erschienen in: Der Onkologe 4/2019

25.02.2019 | Prostatakarzinom | Leitthema

Aktuelle medikamentöse Therapiekonzepte des metastasierten Prostatakarzinoms

verfasst von: Dr. med. Sophie Knipper, Maria De Santis, Marc-Oliver Grimm, Thomas Steuber

Erschienen in: Die Onkologie | Ausgabe 4/2019

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Zusammenfassung

Hintergrund

Seit der Einführung der Androgendeprivationstherapie (ADT) vor mehr als 70 Jahren durch chirurgische Kastration hat sich die medikamentöse Therapie des metastasierten Prostatakarzinoms (PCa) erheblich diversifiziert. Durch neues Verständnis der Resistenzmechanismen gegenüber ADT sowie Chemotherapie stehen derzeit fünf zugelassene Medikamente zur Therapie zur Verfügung, die sich unterschiedlicher Wirkmechanismen bedienen.

Ergebnisse

Durch Verschiebung der Therapiezeitpunkte in Richtung frühen Einsatz beim metastasierten hormonsensitiven PCa (mHSPC) konnten weitere, signifikante Überlebensvorteile beobachtet werden. Neue Studien zu Sequenz und/oder Kombination der vorhandenen Präparate setzen weiteres Potenzial der Therapieoptimierung des metastasierten kastrationsresistenten PCa (mCRPC) frei. Diese Untersuchungen werden möglicherweise durch innovative Therapiekonzepte weiterhin verbessert und neue Zulassungen werden insbesondere beim M0 CRPC erwartet. Zudem laufen Studien, die den Stellenwert der Primariustherapie und/oder Metastasenbehandlung auf Symptome und Prognose untersuchen.

Schlussfolgerung

Aus Sicht der Autoren wird die Therapie des metastasierten PCa in Zukunft multimodal, interdisziplinär und individuell gestaltet werden müssen, um eine Chronifizierung der Tumorerkrankung bei guter Lebensqualität zu erreichen.
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Metadaten
Titel
Aktuelle medikamentöse Therapiekonzepte des metastasierten Prostatakarzinoms
verfasst von
Dr. med. Sophie Knipper
Maria De Santis
Marc-Oliver Grimm
Thomas Steuber
Publikationsdatum
25.02.2019
Verlag
Springer Medizin
Erschienen in
Die Onkologie / Ausgabe 4/2019
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-019-0538-9

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Prostatakarzinom

Palliativmedizin und Supportivtherapie

Algorithmus Tumorschmerztherapie

Passend zum Thema

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Bei Immuntherapien das erhöhte Thromboserisiko beachten

Unter modernen Systemtherapien versechsfacht sich das VTE-Risiko. Warum diese Daten relevant für die Behandlung krebsassoziierter Thrombosen sind, erläutert Prof. F. Langer im Interview. So kann es durch Immuntherapien zu inflammatorischen Syndromen z.B. im GI-Trakt kommen. Nebenwirkungen wie Durchfall oder Mukositis haben dann Einfluss auf die Wirksamkeit oraler Antikoagulantien. Aber auch in punkto Blutungsrisiko ist Vorsicht geboten. Wann hier bevorzugt NMH eingesetzt werden sollten, erläutert Prof. Langer im Interview.

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CAT-Management ist ganz einfach – oder doch nicht?

Krebsassoziierte venöse Thromboembolien (CAT) haben in den vergangenen Jahren stetig zugenommen. Was hat der Anstieg mit modernen Antitumortherapien zu tun? Venöse Thromboembolien sind relevante Morbiditäts- und Mortalitätsfaktoren in der Onkologie. Besonders hoch sind die Risiken bei Tumoren des Abdominalraums. Eine antithrombotische Primärprophylaxe ist daher gerade bei gastrointestinalen (GI-) Tumoren auch im ambulanten Setting wichtig.

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Management von Thromboembolien bei Krebspatienten

Die Thromboembolie ist neben Infektionen die zweithäufigste Todesursache bei Krebspatienten. Die Behandlung der CAT (cancer associated thrombosis) ist komplex und orientiert sich am individuellen Patienten. Angesichts einer Vielzahl zur Verfügung stehender medikamentöser Behandlungsoptionen finden Sie hier Video-Experteninterviews, Sonderpublikationen und aktuelle Behandlungsalgorithmen zur Therapieentscheidung auf Basis von Expertenempfehlungen.

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