Neue Hormontherapien beim metastasierten Prostatakarzinom
Tóm tắt
Die Androgendeprivationstherapie ist seit den 1970er Jahren die Standardtherapie des fortgeschrittenen oder metastasierten Prostatakarzinoms. Nach einiger Zeit unter Androgenentzug lernt das Prostatakarzinom jedoch, unter diesen Umständen zu leben und wird kastrationsresistent. In diesem Stadium der Erkrankung nutzt das Prostatakarzinom die androgene Signalkaskade weiterhin, sodass zu deren Unterbrechung neue Hormontherapien der zweiten Generation entwickelt wurden. Es handelt sich dabei um die Wirkstoffe Abirateron, Enzalutamid, Apalutamid und Darolutamid. Diese setzen an verschiedenen Stellen der androgenen Signalkaskade an, mit dem Ziel, verschiedene androgene Resistenzmechanismen des Prostatakarzinoms zu unterbinden. Die neuen Hormontherapien werden in Kombination mit der Standardandrogendeprivationstherapie verabreicht. Initial für das metastasierte kastrationsresistente Prostatakarzinom etabliert, veränderten die neuen Hormontherapien auch die Therapie des nichtmetastasierten kastrationsresistenten und des metastasierten hormonsensitiven Prostatakarzinoms grundlegend. Die Erkenntnis, dass äusserst niedrige Testosteronspiegel während des initialen Androgenentzugs mit einer verzögerten Progression der Erkrankung und schlussendlich einem verbesserten Überleben assoziiert sind, führte zu verschiedenen Kombinationstherapien bereits im metastasierten hormonsensitiven Stadium. In diesem früheren Krankheitsstadium zeigten die Hormontherapien der neuen Generation die grösste Wirkung und führten zu einer Verbesserung des Gesamtüberlebens von ca. 30–40 % gegenüber der alleinigen Androgendeprivationstherapie.
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