Therapie des metastasierten kastrationsresistenten Prostatakarzinoms – aktuelle onkologische Konzepte

Zusammenfassung

Die Einführung zahlreicher neuer Substanzen für die Behandlung des kastrationsresistenten metastasierten Prostatakarzinoms (mCRPC) hat zur einer Vielzahl von möglichen Therapieoptionen geführt. Gleichzeitig ist das Wissen um die ideale Patientenauswahl, die Therapiesequenz und die Entwicklung von Resistenzmechanismen begrenzt.

Neben Docetaxel sind in den letzten Jahren Abirateron, Enzalutamid, Cabazitaxel und ²²³Ra in randomisierten Phase III-Studien als fester Bestandteil der Behandlung des mCRPC hinzugekommen. Aktuell werden Immunonkologika (IO)und PARP (Polyadenosindiphosphatribose)-Inhibitoren intensiv untersucht. Ferner zeigen aktuelle nuklearmedizinische Untersuchungen zur PSMA-Lutetium-Therapie sehr vielversprechende Ergebnisse.

Ziel dieses Artikels ist es, anhand der aktuellen Literatur eine Übersicht über die Therapieoptionen zu geben und gleichzeitig praktische Aspekte bei der Auswahl der optimalen Sequenz für den jeweiligen Patienten zu diskutieren.

Abstract

The introduction of numerous new substances for the treatment of castration-resistant metastatic prostate cancer (mCRPC) over the past years has led to a wide range of possible treatment options. At the same time, knowledge about the ideal patient selection, the optimal therapeutic sequences and the development of resistance mechanisms is limited.

In addition to docetaxel, abiraterone, enzalutamide, cabazitaxel and radium-223 have been added as integral parts of the treatment of mCRPC. Currently, immunoncologica (IO) and PARP (polyadenosine diphosphatribose) inhibitors are being intensively investigated. Furthermore, current studies on PSMA-lutetium therapy showed very promising results.

The aim of this article is to give an overview of the therapy options based on the current literature and at the same time to discuss practical aspects in selecting the optimal sequence for the right patient.

Schlüsselwörter

metastasiert kastrationsresistentes Prostatakarzinom - systemische Therapie - PSMA - Chemotherapie

Keywords

metastasized castration resistant prostate cancer - systemic therapy - PSMA - chemotherapy

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