Ваши коллеги ответили:
ADT monotherapy
ADT + ARTA
ADT + DOC
ADT + DOC + abiraterone or darolutamide
your answer
Prostate cancer
PROSCA cases on the road to the Annual Global Forum on GU OncologyCase 2023: Javier (expert opinion by A. Bahl)
Javier, 67 years old, has two beautiful grandsons who always visit him during the Procesión de Los Reyes. Together they enjoy watching the majestic parade, but mostly they enjoy the collection of sweets and eating the candy. The latter, of course, makes Javier their favourite grandpa. He was recently diagnosed with metastatic PCa.
Assessment summary:
- Medical history: type II diabetes (well-controlled with oral antidiabetic agent)
- ECOG PS: 1
- Symptoms: back pain and weight loss over the last few months
- Bone scan: 8 metastases (4 on ribs, 4 on spine)
- CT scan: locally advanced prostatic mass, few enlarged pelvic lymph nodes
- PSA: 63 ng/ml
- Prostate biopsy: ISUP grade group 5 (Gleason score 4+5)
Expert opinion by A. Bahl
ADT monotherapy
ADT + ARTA
ADT + DOC
ADT + DOC + abiraterone or darolutamide
1-3 неуместно, 4-6 неуверенно, 7-9 уместно
Клиническая перспектива: одобрение регуляторных органов и местные ограничения не учитываются.
Свидетельство
This is a patient with high-volume, synchronous metastatic hormone-sensitive prostate cancer. He has well-controlled type II diabetes, but is otherwise quite fit. Data from phase III randomised trials (e.g. ARASENS, PEACE-I) support the use of triplet therapy, consisting of ADT plus docetaxel plus ARTA [1,2]. As this patient has type II diabetes, darolutamide might be preferred over abiraterone as ARTA, since darolutamide does not require coadministration with steroids. ADT + ARTA alone is also an appropriate option based on trials like LATITUDE, TITAN and ARCHES [3-5]. These 2 options are also recommended by the EAU guidelines [6].
This educational activity is supported by Bayer.
Использованная литература
- Fizazi K, Foulon S, Carles J, et al. Lancet 2022;399:1695-1707. PubMed
- Smith MR, Hussain M, Saad F, et al. N Engl J Med 2022;386:1132-42. PubMed
- Fizazi K, Tran N, Fein L, et al. Lancet Oncol 2019;20:686-700. PubMed
- Chi KN, Chowdhury S, Bjartell A, et al. J Clin Oncol 2021;39:2294-303. PubMed
- Armstrong AJ, Azad AA, Iguchi T, et al. J Clin Oncol 2022;40:1616-22. PubMed
- Mottet N, Cornford P, van den Bergh RCN, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer 2023. Available at: https://uroweb.org/guidelines/prostate-cancer