Kastrationsresistentes Prostatakarzinom 2015

Zusammenfassung

Die Prostatakarzinomerkrankung ist nach wie vor die häufigste urologische Krebserkrankung des älteren Mannes. Bei einigen Patienten entsteht ein metastasiertes Prostatakarzinom welches mit antiandrogener Therapie palliativ über Jahre in einem stabilen Krankheitsgeschehen verlaufen kann. Im Mittel nach 3–4 Jahren entwickeln die betroffenen Männer einen erneuten PSA- und Krankheitsprogress mit der Ausbildung eines sogenannten kastrationsresistenten Tumorleidens. Bis vor 5 Jahren war die zytotoxische Chemotherapie mit Docetaxel die einzige lebensverlängernde Therapieoption in dieser Situation. In den letzten 5 Jahren haben die Ergebnisse von randomisierten Phase III Studien zur Zulassung von 5 neuen Wirkstoffen zur Behandlung des metastasierten kastrationsresistenten Prostatakarzinoms (mCRPC) geführt. Die Ergebnisse und Zulassungssituation der Substanzen, Abirateron, Enzalutamid, Cabazitaxel, Sipuleucel-T und des Radium-223 werden im Nachfolgenden beschrieben. Zudem werden Aspekte der Sequenztherapie und mögliche molekulare Zukunftsansätze diskutiert.

Abstract

Prostate cancer is still the most common urological cancer of the elderly man. In some patients, a metastatic prostate cancer arises which may remain a stable disease for years with palliative antiandrogen therapy. On average, after 3–4 years, affected men develop a PSA rise and disease progression with the formation of a so-called castration-resistant disease. 5 years ago cytotoxic chemotherapy with docetaxel was the only life-prolonging treatment option in this situation. In the last 5 years, the results of randomised phase III studies have led to the approval of 5 new agents for the treatment of metastatic castration resistant prostate cancer (mCRPC). The results and approval status of the substances, Abiraterone, Enzalutamide, Cabazitaxel, Sipuleucel-T and radium-223 are described below. In addition, some aspects of sequential therapy and possible future molecular approaches are discussed.

Schlüsselwörter

Prostatakarzinom - CRPC - neue Therapien - Enzalutamid - Cabazitaxel - Abirateron - Sipuleucel T - Radium-223

Key words

prostate cancer - CRPC - novel treatments - Enzalutamide - Cabazitaxel - Abiraterone - Sipuleucel T - radium-223

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