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Aktuelle Urol 2013; 44(04): 271-276
DOI: 10.1055/s-0033-1348245
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Stellenwert der intermittierenden Androgendeprivation im Kontext der aktuellen Datenlage

Value of Intermittent Androgen Deprivation in the Context of the Current Data Situation
K. Miller
1   Urologische Klinik, Charité, Berlin
,
P. Hammerer
2   Urologische Klinik, Städt. Klinikum Braunschweig
,
R. Eichenauer
3   Urologikum Hamburg
,
G. Geiges
4   Urologische Praxis Berlin
,
J. Lehmann
5   Urologische Praxis Kiel, Belegabteilung städt. Krankenhaus Kiel
,
G. Rodemer
6   Praxisgemeinschaft für Onkologie und Urologie, Wilhelmshaven
,
C. Ruessel
7   Urologische Praxis Borken
,
W. Rulf
8   Urologische Praxis Erkrath
,
H. Suttmann
3   Urologikum Hamburg
,
J. M. Wolff
9   Urologische Klinik, allgemeines Krankenhaus Viersen
› Author Affiliations
Further Information

Publication History

Publication Date:
25 July 2013 (online)

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Zusammenfassung

Die Androgendeprivation ist ein wesentlicher Bestandteil der Behandlung fortgeschrittener Prostatakarzinome. In zahlreichen prospektiv randomisierten Studien wurde der Frage nachgegangen, ob zeitweise Unterbrechungen des Androgenentzugs die Entwicklung einer Kas­trationsresistenz hinauszögern und gleichzeitig die Lebensqualität der Patienten verbessern kann. Ein Herauszögern der Kastrationsresistenz durch intermittierende Androgendeprivation (IAD) wurde in keiner Phase-III-Studie belegt. Die Überlebensdaten der bisherigen Phase-III-Studien zeigten mit Ausnahme einer Untersuchung zumindestens keinen Überlebensnachteil. Die Daten zur Lebensqualität sind uneinheitlich mit einem Trend zur Verbesserung unter IAD. Dass die IAD fester Bestandteil der Behandlungspraxis ist, spiegelt sich sowohl in der deutschen als auch in der europäischen Leitlinie wider. In dieser Übersichtsarbeit soll ein Leitfaden für eine individualisierte Behandlung auf der Basis der aktuell publizierten Studien vorgestellt werden.

Abstract

Androgen deprivation therapy is an integral part of the treatment of advanced and progressive prostate cancer. Various prospective randomised trials have investigated whether or not temporary suspension of androgen deprivation might delay the emergence of castration resistant prostate cancer and concomitantly improve quality of life. Until now, no phase III trial has been able to prove that intermittent androgen deprivation might delay the development of castration resistant tumours. Data from previous trials, except for one study, did at least not show adverse effects on survival. Data on quality of life are inconsistent, showing a trend towards improved quality of life with IAD. German as well as European guidelines reflect IAD as an established constituent of day-to-day medical practice. This review is intended to provide a code of practice for an individualised treatment as based on recently published studies.

Schlüsselwörter

Prostatakarzinom - Hormontherapie - intermittierende ­Androgenblockade

Key words

prostate cancer - hormone therapy - intermittent androgen blockade

Editorial Comment zur Übersicht

 

  • Literatur

  • 1 AWMF/DKG/DeutscheKrebshilfe. Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms. 2011
    PubMedSearch in Google Scholar
  • 2 Heidenreich A, Epplen R, Thüer D et al. D.P and EURO Prostate Center. EAU guideline on advanced prostate cancer: Compliance among urologists concerning androgen deprivation therapy. European Urology Supplements, 2011 2011; 10: 337
    PubMedSearch in Google Scholar
  • 3 Abrahamsson PA. Potential benefits of intermittent androgen suppression therapy in the treatment of prostate cancer: a systematic review of the literature. Eur Urol 2010; 57: 49-59
    CrossrefPubMedSearch in Google Scholar
  • 4 Boccon-Gibod L, Hammerer P, Madersbacher S et al. The role of intermittent androgen deprivation in prostate cancer. BJU Int 2007; 100: 738-743
    CrossrefPubMedSearch in Google Scholar
  • 5 Crook JM, O’Callaghan CJ, Duncan G et al. Intermittent androgen suppression for rising PSA level after radiotherapy. N Engl J Med 2012; 367: 895-903
    CrossrefPubMedSearch in Google Scholar
  • 6 Miller K. Randomised prospective study of intermittent versus continuous androgen suppression in advanced prostate cancer. ASCO Prostate Cancer Symposium Abstract 5015 2007;
    PubMedSearch in Google Scholar
  • 7 Mottet N, Van Damme J, Loulidi S et al. Intermittent hormonal therapy in the treatment of metastatic prostate cancer: a randomized trial. BJU Int 2012; 110: 1262-1269
    CrossrefPubMedSearch in Google Scholar
  • 8 Mottet N. Intermittent Androgen Deprivation Therapy in Prostate Cancer: Is Everything So Clear?. Eur Urol 2012; ePub
    PubMedSearch in Google Scholar
  • 9 Calais da Silva FE, Bono AV, Whelan P et al. Intermittent androgen deprivation for locally advanced and metastatic prostate cancer: results from a randomised phase 3 study of the South European Uroncological Group. Eur Urol 2009; 55: 1269-1277
    CrossrefPubMedSearch in Google Scholar
  • 10 Hussain A. Intermittent versus continuous androgen deprivation in hormone sensitive metastatic prostate cancer patients: Results of S9346 (INT-0162), an international phase III trial. J Clin Oncol 2012; 30 abstr. 4
    PubMedSearch in Google Scholar
  • 11 Moinpour C, Berry DL, Ely B et al. Preliminary quality-of-life outcomes for SWOG-9346: Intermittent androgen deprivation in patients with hormone-sensitive metastatic prostate cancer (HSM1PC)-Phase III. (Poster). J Clin Oncol 30 2012; (suppl; abstr 4571)
    PubMedSearch in Google Scholar
  • 12 Salonen AJ, Taari K, Ala-Opas M et al. Advanced Prostate Cancer Treated with Intermittent or Continuous Androgen Deprivation in the Randomised FinnProstate Study VII: Quality of Life and Adverse Effects. Eur Urol 2012;
    PubMedSearch in Google Scholar
  • 13 Hussain M, Tangen CM, Higano C et al. Absolute prostate-specific antigen value after androgen deprivation is a strong independent predictor of survival in new metastatic prostate cancer: data from Southwest Oncology Group Trial 9346 (INT-0162). J Clin Oncol 2006; 24: 3984-3990
    CrossrefPubMedSearch in Google Scholar
  • 14 Irani J, Celhay O, Hubert J et al. Continuous versus six months a year maximal androgen blockade in the management of prostate cancer: a randomised study. Eur Urol 2008; 54: 382-391
    CrossrefPubMedSearch in Google Scholar
  • 15 Crook JM, O’Callaghan CJ, Duncan G et al. Intermittent androgen suppression for rising PSA level after radiotherapy. N Engl J Med 2012; 367: 895-903
    CrossrefPubMedSearch in Google Scholar
  • 16 Mottet N, Goussard M. 2, Loulidi S.3 and J.4 W. Intermittent versus continuous maximal androgen blockade in metastatic (D2) prostate cancer patients. A randomized trial. Eur Urol Suppl 2009 2009; 8 131: 131
    PubMedSearch in Google Scholar
  • 17 Albers P. New data on androgen deprivation therapy for prostate cancer: What does it mean for your patients?. EAU Symposium 2012;
    PubMedSearch in Google Scholar
  • 18 Kolvenbag GJ, Iversen P, Newling DW. Antiandrogen monotherapy: a new form of treatment for patients with prostate cancer. Urology 2001; 58: 16-23
    PubMedSearch in Google Scholar
  • 19 Klotz L, Boccon-Gibod L, Shore ND et al. The efficacy and safety of degarelix: a 12-month, comparative, randomized, open-label, parallel-group phase III study in patients with prostate cancer. BJU Int 2008; 102: 1531-1538
    CrossrefPubMedSearch in Google Scholar
  • 20 Ferring Arzneimittel GmbH. Fachinformation FIRMAGON® 120 mg Pulver und Lösungsmittel zur Herstellung einer Injektionslösung 2012
    PubMed
  • 21 Shaw GL, Wilson P, Cuzick J et al. International study into the use of intermittent hormone therapy in the treatment of carcinoma of the prostate: a meta-analysis of 1446 patients. BJU Int 2007; 99: 1056-1065
    CrossrefPubMedSearch in Google Scholar
  • 22 Klotz L, Boccon-Gibod L, Shore ND et al. The efficacy and safety of degarelix: a 12-month, comparative, randomized, open-label, parallel-group phase III study in patients with prostate cancer. BJU Int 2008; 102: 1531-1538
    CrossrefPubMedSearch in Google Scholar
  • 23 Tunn UW, Canepa G, Kochanowsky A et al. Testosterone recovery in the off-treatment time in prostate cancer patients undergoing intermittent androgen deprivation therapy. Prostate Cancer P D 2012; 1-7
    PubMedSearch in Google Scholar
  • 24 Langenhuijsen EMC. 2 S and P. H. Intermittent androgen suppression in patients with advanced prostate cancer: an update of the tulp survival data advanced prostate cancer: an update of the tulp survival data. Eur Urol Suppl. 2008 7. 205
    PubMedSearch in Google Scholar
  • 25 de Leval J, Boca P, Yousef E et al. Intermittent versus continuous total androgen blockade in the treatment of patients with advanced hormone-naive prostate cancer: results of a prospective randomized multicenter trial. Clin Prostate Cancer 2002; 1: 163-171
    CrossrefPubMedSearch in Google Scholar