转移性去势抵抗性前列腺癌化疗与激素治疗策略

摘要

以多西他赛为核心的化疗方案已经成为转移性去势抵抗性前列腺癌（ metastatic castrate－resistant prostate cancer，mCRPC）治疗的一线方案。但在过去的几年中，一些新药的出现改善了患者的总体生存，同时也使优化个体化治疗方案成为可能。已有证据表明阿比特龙、卡巴他赛、镭－223、sipuleucel－T、恩杂鲁胺等与多西他赛一同使去势抵抗性前列腺癌患者生存获益。另外，mCRPC患者对多西他赛一线治疗初始反应良好，出现疾病进展后复治应作为一线治疗的延伸。这些新的治疗手段使mCRPC治疗方案更加复杂化，并且使以往的序贯治疗方案向基于一定规则的新的治疗方式转变。%Chemotherapy with docetaxel has become the first line treatment for metastatic castrate-resistantprostate canc-er ( mCRPC) , in the last few years, new agents have been developed to improve survival obviously in this setting and reach a possible optimal personalized treatment strategy.There is evidence to suggest that abiratone acetate, cabazitaxel, radium-223, sipuleucel-T and enzalutamide, together with docetaxel, have demonstrated a survival benefit in these pa-tients.The use of rechallenge with docetaxel in mCRPC patients with disease progression after a first response in the first line treatment should been considered as the extension.These new agents make the scenario more complicated and the chal-lenge to move from the old sequential to a new algorithm-based approach.