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Aktuelle Urol 2016; 47(05): 395-401
DOI: 10.1055/s-0042-108533
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Strategien für die Erstlinientherapie des mCRPC

Strategies for First-Line Treatment of mCRPC
K. Miller
1   Urologische Klinik Charité Berlin
,
J. Gschwend
2   Urologische Klinik, Klinikum rechts der Isar, Technische Universität München
,
J.-M. Wolff
3   Urologische Klinik Golzheim
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
28. September 2016 (online)

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Zusammenfassung

In der Erstlinientherapie des nicht oder mild symptomatischen, metastasierten kastrationsresistenten Prostatakarzinoms (mCRPC) kommen derzeit vor allem Abirateronacetat und Enzalutamid zum Einsatz. Da beide Wirkstoffe in den jeweiligen Zulassungsstudien eine vergleichbare klinische Wirksamkeit gezeigt haben, spielen bei der Wahl der Therapie zusätzliche Faktoren eine Rolle. Da mCRPC-Patienten im Regelfall mehrere Therapielinien erhalten, könnten zu diesen Faktoren unterschiedliche, zum Therapieversagen führende Anpassungs- und Resistenzmechanismen Hierfür sprechen Beobachtungen aus dem klinischen Alltag und erste Studien zur Resistenz sowie zur Sequenz. Bis zur Bestätigung einer klinischen Relevanz bestimmen jedoch vor allem Nebenwirkungen der Therapie sowie Komorbiditäten des Patienten die Entscheidung, mit welchem Medikament die Erstlinientherapie des mCRPC erfolgt. Auch potentielle Wechselwirkungen mit der individuellen Komedikation und Präferenzen des Patienten sollten berücksichtigt werden. Neben der Wahl des Medikamentes ist in der Erstlinientherapie des mCRPC der Zeitpunkt ihres Beginns Gegenstand aktueller Diskussionen. So gibt es speziell für Abirateronacetat mehrere Hinweise, dass die Patienten womöglich von einem frühen Einsatz im Rahmen der Indikation profitieren. Da die Bestätigung der klinischen Bedeutung unterschiedlicher Resistenzentwicklungen und unterschiedlicher Wirksamkeit verschiedener Sequenzen beim mCRPC ein starkes Argument für Therapieentscheidungen wäre, sollte dies in prospektiven klinischen Studien überprüft werden.

Abstract

At present, abiraterone acetate and enzalutamide are the most commonly used substances in the first-line treatment of asymptomatic or mildly symptomatic metastatic castration-resistant prostate carcinoma (mCRPC). Since the relevant pivotal trials have demonstrated comparable clinical efficacy for both substances, further factors should be considered for the choice of treatment. As mCRPC patients usually receive several lines of treatment, different adaptation and resistance mechanisms leading to treatment failure could be important. This is indicated by daily routine observations and some initial clinical studies on resistance and different sequences of therapy. However, until the clinical relevance has been confirmed, it is mostly adverse events and comorbidities that are taken into account for the choice of first-line therapy. Also potential interactions with comedications and patient preferences should be considered. In the first-line treatment of mCRPC, ongoing discussions not only centre around the choice of medication for first-line mCRPC therapy, but also around the point in time they are started. For abiraterone acetate, for example, there is confirmed evidence that patients may benefit from early use within the approved indication. If the clinical importance of the different resistance mechanisms and differences in efficacy of various sequences could be confirmed, this would be a strong argument for therapy decisions and should therefore be further analysed in prospective clinical studies.

Schlüsselwörter

metastasiertes kastrationsresistentes Prostatakarzinom - Erstlinientherapie - Abirateron - Enzalutamid

Key words

metastatic castration-resistant prostate cancer - first-line treatment - abiraterone - enzalutamide
 

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