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31.10.2016 | Prostatakarzinom | CME

Systemische Therapie des metastasierten Prostatakarzinoms

verfasst von: Univ. Prof. Dr. med. Anja Lorch

Erschienen in: Die Onkologie | Ausgabe 3/2017

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Zusammenfassung

Zur Behandlung von Patienten mit metastasiertem kastrationssensitivem (mCSPC) und kastrationsresistentem Prostatakarzinom (mCRPC) stehen aktuell verschiedene therapeutische Optionen mit unterschiedlichen Wirkprinzipien zur Wahl. Beim mCSPC konnte in verschiedenen Studien gezeigt werden, dass neben der Standardtherapie mittels Androgendeprivation (ADT-Therapie) der frühzeitige Einsatz einer Chemotherapie mit Docetaxel eine signifikante Verlängerung des Gesamtüberlebens erzielen kann. Besonders Patienten mit hoher Tumorlast profitieren dabei. Basierend auf den Ergebnissen wird daher der Einsatz der Chemotherapie bereits beim mCSPC, insbesondere bei Patienten mit hoher Tumorlast empfohlen. Durch die Entwicklung neuerer Substanzen wie Abirateron und Enzalutamid, den α-Strahler Radium-223, einsetzbar bei Patienten mit ausschließlich ossärer Metastasierung und den klassischen Chemotherapeutika Docetaxel in der Erst- und Cabazitaxel in der Zweitlinie ist es gelungen, die Prognose des mCRPC deutlich zu verbessern und die Überlebenszeit signifikant zu verlängern. Die optimale Therapiesequenz bleibt dabei weiter unklar; es liegen bislang nur wenige, meist retrospektive Daten an kleinen Fallzahlen vor. Weitere prospektive Studien sind erforderlich, um neue Erkenntnisse über sinnvolle Sequenzen zu gewinnen. Eine Kreuzresistenz zwischen Enzalutamid und Abirateron, vermittelt z. B. durch die Androgen-Rezeptor Splicevariante 7, ist eine mögliche Ursache einer reduzierten Effektivität in nachfolgenden Therapielinien. Neben den bereits zugelassenen Medikamenten befinden sich weitere Substanzen in der klinischen und vorklinischen Entwicklung.
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Metadaten
Titel
Systemische Therapie des metastasierten Prostatakarzinoms
verfasst von
Univ. Prof. Dr. med. Anja Lorch
Publikationsdatum
31.10.2016
Verlag
Springer Medizin
Erschienen in
Die Onkologie / Ausgabe 3/2017
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-016-0132-3

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