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Novas Abordagens Terapêuticas do Cancro da Próstata
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Introdução: As opções terapêuticas no cancro da próstata metastático resistente à castração (CPmRC), uma vez refratário à quimioterapia baseada em docetaxel eram até à última década limitadas. Atualmente, as opções terapêuticas pós-docetaxel, incluem a utilização de novos agentes hormonais, nomeadamente o acetato de abiraterona (AA) e a enzalutamida (ENZ). Ambos os fármacos tem demonstrado um aumento da sobrevivência global. Este estudo, descreve a experiência quanto à eficácia e tolerância destes agentes hormonais no tratamento do CPmRC pós-docetaxel. Métodos: Estudo retrospetivo dos doentes com CPmRC sob terapêutica com AA ou ENZ, após terapêutica com docetaxel, seguidos no Serviço de Oncologia do CHLO (HSFX) entre 2016 e 2018. Resultados: Dos doentes incluídos no estudo (n=25), 72% estavam sob terapêutica com AA e os restantes foram tratados com ENZ. A mediana de idades foi de 75 anos (45-92), 22 doentes apresentavam ECOG PS 0-1 e todos apresentavam doença em estadio IV. A taxa de resposta de PSA total foi 35%. No grupo tratado com AA a mediana da sobrevivência livre de progressão (SLP) foi estimada em 8,2 meses (IC 95% 0,20 – 71,83) e o tempo para progressão do PSA (tPSA) foi de 5,7 meses. A taxa de resposta ao PSA l foi de 29%. No grupo tratado com a ENZ a mediana da SLP foi de 4,6 meses (IC 95% 0,77 – 5,90) e o tPSA apresentou uma mediana de 3,7 meses. A taxa de resposta ao PSA foi 50%. Conclusão: As taxas de resposta ao PSA de ambos os fármacos são compatíveis com o descrito nos ensaios clínicos. A seleção da terapêutica (AA ou ENZ) é condicionada pelo perfil de prescrição crónico de medicamentos para outras patologias. O valor de PSA é um bom fator de preditivo de resposta à terapêutica.
Background: Until 2010, patients with metastatic castration-resistant prostate cancer (mCRPC) had limited therapeutic options once they became refractory to docetaxel. Currently, the post-docetaxel therapeutic options, include abiraterone acetate (AA) and enzalutamide (ENZ). Both drugs have shown increase in overall survival. This study describes the clinical experience regarding efficacy and tolerability of the above mentioned hormonal agents in treatment of mCRPC after docetaxel. Methods: Retrospective review of patients with mCRPC on AA or ENZ therapy in Serviço de Oncologia do CHLO between 2016 and 2018. Results: In terms of the patients included in the study (n = 25), 72% were on AA therapy and the remainder were treated with ENZ. The median age was 75 years old [45-92] and 22 patients had ECOG performance status 0-1 and all of the patients were in stage disease IV. PSA response rate was 35%. In the AA treated group the median progression-free survival (PFS) was 8,17 months (IC 95% 0,20 – 71,83) and the median time to PSA progression (tPSA) was 5,7 months. PSA response rate was 29%. In the ENZ treated group the median of PFS was 4,6 months ((IC 95% 0,77 – 5,90)) and the median tPSA was 3,7 months. PSA response rate was 50%. Conclusion: The PSA response rates for both drugs are consistent with those described in clinical trials. The selection of therapy (AA or ENZ) is conditioned by the chronic prescription drugs profile for other diseases. The PSA is a good predictor of response to therapy.
Background: Until 2010, patients with metastatic castration-resistant prostate cancer (mCRPC) had limited therapeutic options once they became refractory to docetaxel. Currently, the post-docetaxel therapeutic options, include abiraterone acetate (AA) and enzalutamide (ENZ). Both drugs have shown increase in overall survival. This study describes the clinical experience regarding efficacy and tolerability of the above mentioned hormonal agents in treatment of mCRPC after docetaxel. Methods: Retrospective review of patients with mCRPC on AA or ENZ therapy in Serviço de Oncologia do CHLO between 2016 and 2018. Results: In terms of the patients included in the study (n = 25), 72% were on AA therapy and the remainder were treated with ENZ. The median age was 75 years old [45-92] and 22 patients had ECOG performance status 0-1 and all of the patients were in stage disease IV. PSA response rate was 35%. In the AA treated group the median progression-free survival (PFS) was 8,17 months (IC 95% 0,20 – 71,83) and the median time to PSA progression (tPSA) was 5,7 months. PSA response rate was 29%. In the ENZ treated group the median of PFS was 4,6 months ((IC 95% 0,77 – 5,90)) and the median tPSA was 3,7 months. PSA response rate was 50%. Conclusion: The PSA response rates for both drugs are consistent with those described in clinical trials. The selection of therapy (AA or ENZ) is conditioned by the chronic prescription drugs profile for other diseases. The PSA is a good predictor of response to therapy.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2019
Palavras-chave
Cancro da Próstata Resistente à Castração Acetato de Abiraterona Enzalutamida Mestrado Integrado - 2019