-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
- Cosmetic Ingredient
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
In the past, ASCO has issued clinical practice guidelines for the initial hormone therapy of non-castrated prostate cancer.
A few days ago, the ASCO expert panel updated the initial treatment recommendations for advanced, recurrent or metastatic non-castrated prostate cancer.
This update is mainly based on 4 clinical practice guidelines, 1 clinical practice guidelines endorsement, 19 systematic reviews with or without meta-analysis, 47 phase III randomized controlled studies, 9 cohort studies and 2 review papers.
Clinical question 1: What is the standard initial treatment for metastatic non-castrated prostate cancer? Recommendation 1.
0: Docetaxel, abiraterone, enzalutamide or apatamide combined with androgen deprivation therapy (ADT) are metastatic Four different standard treatment options for non-castrated prostate cancer patients.
The best combination therapy cannot be recommended yet (type: evidence-based, advantages and disadvantages unknown; strength of evidence: no evidence available; strength of recommendation: strong).
ADT+Docetaxel recommendation 1.
1: According to the CHAARTED study, patients with metastatic non-castrated prostate cancer with high tumor burden should be treated with docetaxel+ADT if they are suitable for chemotherapy (Type: based on evidence, the advantages outweigh the disadvantages; strength of evidence : High; recommended intensity: strong for patients with high tumor burden).
Recommendation 1.
2: For patients with metastatic disease defined as low tumor burden according to the CHAARTED study, if chemotherapy is suitable, docetaxel + ADT should not be given (Type: evidence-based, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: low tumor Load patients are strong).
Recommendation 1.
3: For patients with metastatic non-castrated prostate cancer, the recommended dose of docetaxel as a single agent (CHAARTED study) or docetaxel + prednisolone regimen (STAMPEDE study) is 75 mg/ m2, administered every three weeks, a total of 6 doses (Type: evidence-based, the advantages outweigh the disadvantages; the quality of evidence: high; the strength of recommendation: strong).ADT+Abiraterone Recommendation 1.
4: For patients with high-risk new-onset metastatic non-castrated prostate cancer, according to the LATITUDE study, ADT+Abiraterone can be given (Type: evidence-based, the advantages outweigh the disadvantages; the quality of evidence: high; the strength of the recommendation: LATITUDE Patients with high-risk diseases defined by the study are strong).
Recommendation 1.
5: For patients with low-risk new-onset metastatic non-castrated prostate cancer, according to the STAMPEDE study, ADT+Abiraterone may be given (Type: evidence-based, the advantages outweigh the disadvantages; the quality of the evidence: high; the strength of the recommendation: low as defined by the STAMPEDE study Patients at risk are medium).
Recommendation 1.
6: For patients with metastatic non-castrated prostate cancer, the recommended dosing regimen is abiraterone (1000mg) + prednisolone (5mg) or prednisone (5mg) once a day until the disease progresses (type: Based on evidence, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: strong).
ADT+Enzalutamide Recommendation 1.
7: ADT+Enzalutamide is used for patients with metastatic non-castrated prostate cancer, including patients with new metastatic prostate cancer and previous local treatments including radical prostatectomy (RP) or radiotherapy ( RT) patients.
The ENZAMET study showed that for patients with metastatic non-castrated prostate cancer, compared with ADT alone, ADT+Enzalutamide had better short-term survival benefits (PSA progression-free survival, clinical progression-free survival, and overall survival) ( Type: Based on evidence, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: strong).
Recommendation 1.
8: For patients with metastatic non-castrated prostate cancer, the recommended treatment plan is enzalutamide (160mg/day) + ADT (type: evidence-based, the advantages outweigh the disadvantages; the quality of evidence: high; the strength of the recommendation: strong).
ADT+Apatamide Recommendation 1.
9: According to the TITAN study, for patients with metastatic non-castrated prostate cancer, including patients with new-onset metastatic prostate cancer or patients who have previously received local treatment (RP or RT), ADT+Apa can be given Tamide (Type: based on evidence, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: strong). Recommendation 1.
95: For patients with metastatic non-castrated prostate cancer, the recommended dosing regimen is apatamide (240mg/day) + ADT (Type: evidence-based, the advantages outweigh the disadvantages; the quality of the evidence: high; the strength of the recommendation: strong) .
Clinical question 2: For patients with locally advanced non-metastatic non-castrated prostate cancer, is combination therapy with anti-androgen blockade (castration + non-steroidal anti-androgen) superior to castration therapy alone? Recommendation 2.
1: According to the failure-free survival (FFS) results of the STAMPEDE study, for patients with locally advanced non-metastatic, non-castrated prostate cancer, ADT + abiraterone + prednisolone can be considered instead of castration therapy alone.
In the STAMPEDE study, all newly diagnosed lymph node-negative patients were treated with radiotherapy; for newly diagnosed lymph node-positive non-metastatic patients, radiotherapy was also encouraged.
Although the treatment time of ADT+abiraterone is up to 2 years, compared with patients receiving ADT treatment alone, ADT+abiraterone+prednisolone can significantly improve FFS in patients with non-metastatic prostate cancer (type: based on evidence, benefits are greater than Disadvantages; quality of evidence: high; strength of recommendation: strong).
Recommendation 2.
2: In the case of limited resources, for example, abiraterone and other drugs are not timely, for patients with locally advanced non-metastatic prostate cancer, ADT + first-generation anti-androgen drugs (such as flutamide, nilutamide or Kalutamide) instead of castration therapy alone (based on a recent Meta-analysis) (Type: evidence-based; quality of evidence: high, the advantages outweigh the disadvantages; strength of recommendation: medium).
Clinical question 3: For patients with locally advanced non-metastatic, non-castrated prostate cancer, can early ADT improve the prognosis better than delayed treatment? Recommendation 3.
1: Based on a meta-analysis, early ADT can be given to patients who are newly diagnosed with locally advanced non-metastatic non-castrated prostate cancer, have not received local treatment in the past, and are unwilling or intolerant to RT.
Early ADT can bring overall survival (OS) and disease-specific survival (CSS) benefits to most patients with locally advanced non-metastatic prostate cancer (Type: evidence-based, the advantages outweigh the disadvantages; quality of evidence: medium; strength of recommendation :in).
Clinical question 4: For patients with biochemically recurrent non-metastatic prostate cancer, is intermittent ADT better than continuous ADT? Recommendation 4.
1: A meta-analysis showed that for patients with high-risk biochemical recurrence and non-metastatic prostate cancer after receiving RP or RT treatment, the OS results of intermittent androgen deprivation therapy (IADT) are not inferior to continuous androgen deprivation therapy (CADT).
Therefore, for such patients, IADT can be given.
The other 4 meta-analysis also support this result.
Low-risk biochemical recurrence after RP was defined as PSA doubling time> 1 year and pathological Gleason score <8.
Low-risk biochemical recurrence after RT was defined as the biochemical recurrence interval> 18 months and the clinical Gleason score <8.
High-risk biochemical recurrence after RP is defined as PSA doubling time <1 year or pathological Gleason score of 8-10.
High-risk biochemical recurrence after RT is defined as a biochemical recurrence interval <18 months or a clinical Gleason score of 8-10.
Active monitoring can be carried out for patients with low-risk biochemical recurrence and non-metastatic prostate cancer (Type: evidence-based, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: strong).
Figure The recommended path of initial management strategies for patients with advanced recurrent or metastatic non-castrated prostate cancer.
References: Virgo KS, Rumble RB, de Wit R, Mendelson DS, Smith TJ, Taplin ME, Wade JL 3rd, Bennett CL, Scher HI , Nguyen PL, Gleave M, Morgan SC, Loblaw A, Sachdev S, Graham DL, Vapiwala N, Sion AM, Simons VH, Talcott J.
Initial Management of Noncastrate Advanced, Recurrent, or Metastatic Prostate Cancer: ASCO Guideline Update.
J Clin Oncol.
2021 Jan 26:JCO2003256.
doi: 10.
1200/JCO.
20.
03256.
Epub ahead of print.
PMID: 33497248.
A few days ago, the ASCO expert panel updated the initial treatment recommendations for advanced, recurrent or metastatic non-castrated prostate cancer.
This update is mainly based on 4 clinical practice guidelines, 1 clinical practice guidelines endorsement, 19 systematic reviews with or without meta-analysis, 47 phase III randomized controlled studies, 9 cohort studies and 2 review papers.
Clinical question 1: What is the standard initial treatment for metastatic non-castrated prostate cancer? Recommendation 1.
0: Docetaxel, abiraterone, enzalutamide or apatamide combined with androgen deprivation therapy (ADT) are metastatic Four different standard treatment options for non-castrated prostate cancer patients.
The best combination therapy cannot be recommended yet (type: evidence-based, advantages and disadvantages unknown; strength of evidence: no evidence available; strength of recommendation: strong).
ADT+Docetaxel recommendation 1.
1: According to the CHAARTED study, patients with metastatic non-castrated prostate cancer with high tumor burden should be treated with docetaxel+ADT if they are suitable for chemotherapy (Type: based on evidence, the advantages outweigh the disadvantages; strength of evidence : High; recommended intensity: strong for patients with high tumor burden).
Recommendation 1.
2: For patients with metastatic disease defined as low tumor burden according to the CHAARTED study, if chemotherapy is suitable, docetaxel + ADT should not be given (Type: evidence-based, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: low tumor Load patients are strong).
Recommendation 1.
3: For patients with metastatic non-castrated prostate cancer, the recommended dose of docetaxel as a single agent (CHAARTED study) or docetaxel + prednisolone regimen (STAMPEDE study) is 75 mg/ m2, administered every three weeks, a total of 6 doses (Type: evidence-based, the advantages outweigh the disadvantages; the quality of evidence: high; the strength of recommendation: strong).ADT+Abiraterone Recommendation 1.
4: For patients with high-risk new-onset metastatic non-castrated prostate cancer, according to the LATITUDE study, ADT+Abiraterone can be given (Type: evidence-based, the advantages outweigh the disadvantages; the quality of evidence: high; the strength of the recommendation: LATITUDE Patients with high-risk diseases defined by the study are strong).
Recommendation 1.
5: For patients with low-risk new-onset metastatic non-castrated prostate cancer, according to the STAMPEDE study, ADT+Abiraterone may be given (Type: evidence-based, the advantages outweigh the disadvantages; the quality of the evidence: high; the strength of the recommendation: low as defined by the STAMPEDE study Patients at risk are medium).
Recommendation 1.
6: For patients with metastatic non-castrated prostate cancer, the recommended dosing regimen is abiraterone (1000mg) + prednisolone (5mg) or prednisone (5mg) once a day until the disease progresses (type: Based on evidence, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: strong).
ADT+Enzalutamide Recommendation 1.
7: ADT+Enzalutamide is used for patients with metastatic non-castrated prostate cancer, including patients with new metastatic prostate cancer and previous local treatments including radical prostatectomy (RP) or radiotherapy ( RT) patients.
The ENZAMET study showed that for patients with metastatic non-castrated prostate cancer, compared with ADT alone, ADT+Enzalutamide had better short-term survival benefits (PSA progression-free survival, clinical progression-free survival, and overall survival) ( Type: Based on evidence, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: strong).
Recommendation 1.
8: For patients with metastatic non-castrated prostate cancer, the recommended treatment plan is enzalutamide (160mg/day) + ADT (type: evidence-based, the advantages outweigh the disadvantages; the quality of evidence: high; the strength of the recommendation: strong).
ADT+Apatamide Recommendation 1.
9: According to the TITAN study, for patients with metastatic non-castrated prostate cancer, including patients with new-onset metastatic prostate cancer or patients who have previously received local treatment (RP or RT), ADT+Apa can be given Tamide (Type: based on evidence, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: strong). Recommendation 1.
95: For patients with metastatic non-castrated prostate cancer, the recommended dosing regimen is apatamide (240mg/day) + ADT (Type: evidence-based, the advantages outweigh the disadvantages; the quality of the evidence: high; the strength of the recommendation: strong) .
Clinical question 2: For patients with locally advanced non-metastatic non-castrated prostate cancer, is combination therapy with anti-androgen blockade (castration + non-steroidal anti-androgen) superior to castration therapy alone? Recommendation 2.
1: According to the failure-free survival (FFS) results of the STAMPEDE study, for patients with locally advanced non-metastatic, non-castrated prostate cancer, ADT + abiraterone + prednisolone can be considered instead of castration therapy alone.
In the STAMPEDE study, all newly diagnosed lymph node-negative patients were treated with radiotherapy; for newly diagnosed lymph node-positive non-metastatic patients, radiotherapy was also encouraged.
Although the treatment time of ADT+abiraterone is up to 2 years, compared with patients receiving ADT treatment alone, ADT+abiraterone+prednisolone can significantly improve FFS in patients with non-metastatic prostate cancer (type: based on evidence, benefits are greater than Disadvantages; quality of evidence: high; strength of recommendation: strong).
Recommendation 2.
2: In the case of limited resources, for example, abiraterone and other drugs are not timely, for patients with locally advanced non-metastatic prostate cancer, ADT + first-generation anti-androgen drugs (such as flutamide, nilutamide or Kalutamide) instead of castration therapy alone (based on a recent Meta-analysis) (Type: evidence-based; quality of evidence: high, the advantages outweigh the disadvantages; strength of recommendation: medium).
Clinical question 3: For patients with locally advanced non-metastatic, non-castrated prostate cancer, can early ADT improve the prognosis better than delayed treatment? Recommendation 3.
1: Based on a meta-analysis, early ADT can be given to patients who are newly diagnosed with locally advanced non-metastatic non-castrated prostate cancer, have not received local treatment in the past, and are unwilling or intolerant to RT.
Early ADT can bring overall survival (OS) and disease-specific survival (CSS) benefits to most patients with locally advanced non-metastatic prostate cancer (Type: evidence-based, the advantages outweigh the disadvantages; quality of evidence: medium; strength of recommendation :in).
Clinical question 4: For patients with biochemically recurrent non-metastatic prostate cancer, is intermittent ADT better than continuous ADT? Recommendation 4.
1: A meta-analysis showed that for patients with high-risk biochemical recurrence and non-metastatic prostate cancer after receiving RP or RT treatment, the OS results of intermittent androgen deprivation therapy (IADT) are not inferior to continuous androgen deprivation therapy (CADT).
Therefore, for such patients, IADT can be given.
The other 4 meta-analysis also support this result.
Low-risk biochemical recurrence after RP was defined as PSA doubling time> 1 year and pathological Gleason score <8.
Low-risk biochemical recurrence after RT was defined as the biochemical recurrence interval> 18 months and the clinical Gleason score <8.
High-risk biochemical recurrence after RP is defined as PSA doubling time <1 year or pathological Gleason score of 8-10.
High-risk biochemical recurrence after RT is defined as a biochemical recurrence interval <18 months or a clinical Gleason score of 8-10.
Active monitoring can be carried out for patients with low-risk biochemical recurrence and non-metastatic prostate cancer (Type: evidence-based, the advantages outweigh the disadvantages; quality of evidence: high; strength of recommendation: strong).
Figure The recommended path of initial management strategies for patients with advanced recurrent or metastatic non-castrated prostate cancer.
References: Virgo KS, Rumble RB, de Wit R, Mendelson DS, Smith TJ, Taplin ME, Wade JL 3rd, Bennett CL, Scher HI , Nguyen PL, Gleave M, Morgan SC, Loblaw A, Sachdev S, Graham DL, Vapiwala N, Sion AM, Simons VH, Talcott J.
Initial Management of Noncastrate Advanced, Recurrent, or Metastatic Prostate Cancer: ASCO Guideline Update.
J Clin Oncol.
2021 Jan 26:JCO2003256.
doi: 10.
1200/JCO.
20.
03256.
Epub ahead of print.
PMID: 33497248.
