演題抄録

臓器別シンポジウム

開催概要
開催回
第58回・2020年・京都
 

進行性去勢感受性前立腺癌に対するアビラテロンの有効性と問題点

演題番号 : SY8-2

[筆頭演者]
上村 博司:1 
[共同演者]
三好 康秀:1、河原 崇司:1

1:横浜市立大学附属市民総合医療センター・泌尿器腎移植科

 

Recently, the treatment options for hormone naïve prostate cancer (mHNPC) have expanded, which were based on the solid evidence from each global phase III trial. Consequently, the treatment landscape has been changing dramatically with 4 agents that were previously used for castration resistant prostate cancer (CRPC).
Abiraterone acetate (AA) is a selective inhibitor of CYP17α hydroxylase enzyme that inhibits androgen biosynthesis. It has been well known that AA plus prednisone (AAP) had improved overall survival (OS) in the patients with metastatic CRPC (mCRPC) in both pre-chemotherapy and post-chemotherapy setting. Furthermore, AAP and androgen deprivation therapy (ADT) demonstrated a significant improvement in radiographic progression-free survival (rPFS) and OS in patients with newly diagnosed, high-risk mHNPC compared with ADT monotherapy (LATITUE study). Similar results of rPFS and OS were shown in the Japanese subgroup analysis as well. High-risk mHNPC was defined as fulfilling ≧2 of 3 factors: Gleason score of ≧8, presence of ≧3 bone metastases and measurable visceral metastases. Apart from LATUTUDE study, STAMPEDE trial recently demonstrated AAP + ADT had significantly improved OS and failure free survival in low risk patients compared with ADT alone. Briefly, patients with mHNPC gain treatment benefit from AAP + ADT irrespective of risk stratification.
Although AAP + ADT has the benefit of OS and disease progression, the relative safety and toxicity should be considered due to the long-term use of AAP. Based on a recent meta-analysis, head-to-head comparison of each treatment showed a significantly higher grade adverse event risk of up-front AAP and up-front docetaxel than ADT. In light of molecular mechanism driving the development of CRPC and disease progression after up-front AAP + ADT, there remains an unmet need to make a decision of sequential treatment. Furthermore, the cost-effectiveness of AAP therapy should be argued.

キーワード

臓器別:前立腺・男性生殖器

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