Skip to main content
Erschienen in: Wiener klinische Wochenschrift 3-4/2016

01.02.2016 | consensus report

Austrian recommendations on Targeted Hormone Therapy for metastatic, castration-resistant prostate cancer

verfasst von: Priv.-Doz. Dr. Anton Ponholzer, Prim. Dr. Wolfgang Loidl, Priv.-Doz. Dr. Jasmin Bektic, Dr. Karl Dorfinger, Dr. Stephan Hruby, Prim. Dr. Klaus Jeschke, Ao. Univ.-Prof. Dr. Gero Kramer, Prim. Univ.-Prof. Dr. Steffen Krause, Dr. Georg Ludvik, Prof. Priv.-Doz. Dr. Mesut Remzi, Dr. Michael Roider, Dr. Franz Stoiber

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 3-4/2016

Einloggen, um Zugang zu erhalten

Summary

In recent years, new therapeutic options have brought improvements in the treatment of metastatic, castration-resistant prostate cancer. Targeted Hormone Therapy (THT) represents a novel therapeutic component for which recent studies have shown a maximum benefit in the time between failure of androgen deprivation therapy (patient is metastatic and still pain-free) and prior to chemotherapy. Prostate cancer experts of the Austrian Society of Urology and Andrology (ÖGU), the Working Group for Urologic Oncology as part of the ÖGU, and the Professional Association of Austrian Urologists (BvU) have developed recommendations for the treatment of patients with asymptomatic or mildly symptomatic metastatic, castration-resistant prostate cancer. The definition of failure of classical hormonal therapy has been based on the guidelines of the German Society of Urology (Deutsche Gesellschaft für Urologie, DGU) and the European Association of Urology (EAU). Criteria for the initiation of treatment with hormonal or chemotherapy include:
  • Castration resistance with increase of prostate-specific antigen (PSA)
  • Evidence of metastases in imaging
  • No or mild symptoms
  • Quality of Life Index of the Eastern Cooperative Oncology Group (ECOG) 0-1 (ECOG 2 requires individualized decision) [1].
Treatment should only be initiated when all of these four criteria are applicable, with the age of the patient being no exclusion criterion. First-line therapies for these patients include abiraterone, enzalutamide, and docetaxel as well as radium-223. The manuscript refers only to treatment regimens available in Austria.
Selection of the initial treatment option—starting with THT or chemotherapy—should be determined based on the individual patient characteristics. When using abiraterone or enzalutamide, re-staging within 3–6 months is recommended.
Literatur
1.
Zurück zum Zitat Ryan CJ, et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol 2015;16(2):152–60. doi:10.1016/S1470-2045(14)71205-7.CrossRefPubMed Ryan CJ, et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol 2015;16(2):152–60. doi:10.​1016/​S1470-2045(14)71205-7.CrossRefPubMed
2.
Zurück zum Zitat Mohler JL. Castration-recurrent prostate cancer is not androgen-independent. Adv Exp Med Biol. 2008;617:223–34.CrossRefPubMed Mohler JL. Castration-recurrent prostate cancer is not androgen-independent. Adv Exp Med Biol. 2008;617:223–34.CrossRefPubMed
3.
Zurück zum Zitat Sun S, Sprenger CC, Vessella RL, Haugk K, Soriano K, et al. Castration resistance in human prostate cancer is conferred by a frequently occurring androgen receptor splice variant. J Clin Invest. 2010;120:2715–30.PubMedCentralCrossRefPubMed Sun S, Sprenger CC, Vessella RL, Haugk K, Soriano K, et al. Castration resistance in human prostate cancer is conferred by a frequently occurring androgen receptor splice variant. J Clin Invest. 2010;120:2715–30.PubMedCentralCrossRefPubMed
4.
Zurück zum Zitat Knudsen KE, Scher HI. Starving the addiction: new opportunities for durable suppression of AR signaling in prostate cancer. Clin Cancer Res. 2009;15(15):4792–8.PubMedCentralCrossRefPubMed Knudsen KE, Scher HI. Starving the addiction: new opportunities for durable suppression of AR signaling in prostate cancer. Clin Cancer Res. 2009;15(15):4792–8.PubMedCentralCrossRefPubMed
5.
Zurück zum Zitat Mostaghel EA, Nelson PS, Lange P, et al. Targeted androgen pathway suppression in localized prostate cancer: a pilot study. J Clin Oncol. 2014;32:229–37.PubMedCentralCrossRefPubMed Mostaghel EA, Nelson PS, Lange P, et al. Targeted androgen pathway suppression in localized prostate cancer: a pilot study. J Clin Oncol. 2014;32:229–37.PubMedCentralCrossRefPubMed
7.
Zurück zum Zitat Scher HI, et al. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol. 2008;26:1148–59.PubMedCentralCrossRefPubMed Scher HI, et al. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol. 2008;26:1148–59.PubMedCentralCrossRefPubMed
8.
Zurück zum Zitat Fizazi K, et al. Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2012;13(10):983–92.CrossRefPubMed Fizazi K, et al. Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2012;13(10):983–92.CrossRefPubMed
10.
Zurück zum Zitat Scher HI, et al. Increased Survival with Enzalutamide in prostate cancer after chemotherapy. N Engl J Med. 2012;367:1187–97.CrossRefPubMed Scher HI, et al. Increased Survival with Enzalutamide in prostate cancer after chemotherapy. N Engl J Med. 2012;367:1187–97.CrossRefPubMed
11.
Zurück zum Zitat Horwich A, et al. Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;00:1–22. Horwich A, et al. Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;00:1–22.
12.
Zurück zum Zitat Heidenreich A, et al. EAU guidelines on prostate cancer. Europ Urol. 2011;59(4):572–83.CrossRef Heidenreich A, et al. EAU guidelines on prostate cancer. Europ Urol. 2011;59(4):572–83.CrossRef
14.
Zurück zum Zitat Tombal B, et al. Enzalutamide in Men with Chemotherapy-Naive Metastatic Castration-Resistant Prostate Cancer (mCRPC): Updated Overall Survival Analysis of the Phase 3 PREVAIL Study. EAU 20.-24.3.2015 Madrid, Oral Presentation. Tombal B, et al. Enzalutamide in Men with Chemotherapy-Naive Metastatic Castration-Resistant Prostate Cancer (mCRPC): Updated Overall Survival Analysis of the Phase 3 PREVAIL Study. EAU 20.-24.3.2015 Madrid, Oral Presentation.
16.
Zurück zum Zitat M Stein. ASCO Annual Meeting. 2014. (30.5–3.6.2014), Oral Presentation. M Stein. ASCO Annual Meeting. 2014. (30.5–3.6.2014), Oral Presentation.
17.
Zurück zum Zitat De Bono J, et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Lancet. 2010;376:1147–54.CrossRefPubMed De Bono J, et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Lancet. 2010;376:1147–54.CrossRefPubMed
18.
Zurück zum Zitat Parker C, et al. Updated analysis of the phase III, double-blind, randomized, multinational study of radium-223 chloride in castration-resistant prostate cancer (CRPC) patients with bone metastases (ALSYMPCA). J Clin Oncol. 2012;30(5):abstract LBA 4512. Parker C, et al. Updated analysis of the phase III, double-blind, randomized, multinational study of radium-223 chloride in castration-resistant prostate cancer (CRPC) patients with bone metastases (ALSYMPCA). J Clin Oncol. 2012;30(5):abstract LBA 4512.
21.
Zurück zum Zitat S3-Leitlinie Prostatakarzinom ILeitliniederQS3zurF. Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms, Version 3.0, September 2014, AWMF-Register-Nummer 043/022OL. S3-Leitlinie Prostatakarzinom ILeitliniederQS3zurF. Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms, Version 3.0, September 2014, AWMF-Register-Nummer 043/022OL.
Metadaten
Titel
Austrian recommendations on Targeted Hormone Therapy for metastatic, castration-resistant prostate cancer
verfasst von
Priv.-Doz. Dr. Anton Ponholzer
Prim. Dr. Wolfgang Loidl
Priv.-Doz. Dr. Jasmin Bektic
Dr. Karl Dorfinger
Dr. Stephan Hruby
Prim. Dr. Klaus Jeschke
Ao. Univ.-Prof. Dr. Gero Kramer
Prim. Univ.-Prof. Dr. Steffen Krause
Dr. Georg Ludvik
Prof. Priv.-Doz. Dr. Mesut Remzi
Dr. Michael Roider
Dr. Franz Stoiber
Publikationsdatum
01.02.2016
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 3-4/2016
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0945-x

Weitere Artikel der Ausgabe 3-4/2016

Wiener klinische Wochenschrift 3-4/2016 Zur Ausgabe

mitteilungen der gesellschaft der ärzte in wien

Veranstaltungen