Die intermittierende Androgenblockade beim fortgeschrittenen Prostatakarzinom – eine Übersicht

Zusammenfassung

Derzeit ist die Androgenblockade der Goldstandard bei der Behandlung des fortgeschrittenen, metastasierten Prostatakarzinoms. Es handelt sich dabei um eine palliative Therapie, bei der innerhalb von 2 Jahren mehr als die Hälfte der Patienten eine Progression erleidet, da der Tumor zunehmend hormonunempfindlich wird. Die Arbeitsgruppe um Bruchovsky postulierte Anfang der 90er-Jahre, dass man durch den intermittierenden Einsatz der Androgenblockade das apoptotische Potenzial erhalten könne und man somit die Entwicklung der Hormonunempfindlichkeit und die Tumorprogression hinauszögern könne. Ebenso sollte sich die Lebensqualität der Patienten durch den periodischen Wechsel von Phasen mit und ohne Behandlung verbessern lassen. Aufgrund der derzeitigen Daten der seither durchgeführten Phase-II- und -III-Studien ist die IAB (intermittierende Androgenblockade) genauso effektiv wie die KAB (kontinuierliche Androgenblockade). Obgleich die Datenbasis für die Lebensqualität und das Gesamtüberleben noch limitiert ist, scheinen die Ergebnisse zumindest vergleichbar zu sein. Unklar ist, welche Patienten am meisten von einer IAB profitieren. Hier sind die Endergebnisse der laufenden Phase-III-Studie abzuwarten.

Abstract

At present androgen ablation therapy is the therapy of choice for the treatment of metastatic prostate cancer. However, in more than 50 % of the patients the disease will ultimately progress within 2 years.On the basis of the postulation from Bruchovsky et al. that intermittent androgen deprivation maintains the apoptotic potential, this may lead to a delay in tumour progression. By periodically changing phases from on to off the treatment quality of life for the patient may be improved. Most recent clinical data of phase II and III studies imply that IAB is equal effective as CAB. Although data about quality of life and overall survival are still limited, results seem to be comparable. In order to decide which patient groups are most likely to benefit from IAB, final phase III results need to be available.

Schlüsselwörter

Androgenblockade - Prostatakarzinom - Lebensqualität - apoptotische Potenzial

Key words

androgen deprivation - prostate cancer - quality of life - apoptotic potential

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