Stellenwert der intermittierenden Androgendeprivation im Kontext der aktuellen Datenlage

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

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