CASTRATION-RESISTANT PROSTATE CANCER: NEW PERSPECTIVES IN PHARMACOLOGICAL TREATMENT


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Prostate cancer remains one of the most actual problems in oncourology due to its high prevalence and resistance to therapy. Within 5 years of active treatment and follow-up, the castration-resistant prostate cancer (CRPC) develops in 10-20% of patients. This type of disease course resists treatments and leads to death. Medical resources distinguish two different forms of CRPC: non-metastatic and metastatic. Such separation is critically important because each of two forms requires different treatment algorithms. This paper summarizes the main outlines of foreign clinical guidelines and reviews the new treatment options for non-metastatic and metastatic CRPC as wells as the design and results of key clinical trials on drug efficiency. To prepare the review, the comprehensive literature search was conducted using PubMed/Medline, the Cochrane Library, EMBASE, CyberLeninka, e-library databases. The search line included phrases containing the following words: prostate cancer, castration-resistant prostate cancer, drug therapy, treatment algorithms, clinical studies, etc. In accordance to foreign guidelines, it is essential to determine the high risk patients with non-metastatic CRPC and promptly apply new therapeutic options including apalutamide and enzalutamide, which have proven being effective in clinical trials as therapies that attenuate the transition of the non-metastatic CRPC to the metastatic stage. Foreign medical guidelines propose to apply a wider set of treatment algorithms for patients with metastatic CRPC, for instance: considerations on possibilities to use the cabazitaxel instead of docetaxel in the 1st line therapy in patients with pre-existing mild peripheral neuropathy, etc. as well as new therapies - pembrolizumab and sipuleucel-T. The issues regarding the selection of patients with CRPC for specific treatment algorithms and defining the optimal sequence of therapeutic regimens as well as combining various regimens with minimizing toxic effects and maximizing patient benefits remain unsolved.

作者简介

Dmitry Andreev

Scientific-Practical Center for Clinical Trials and Healthcare Technology Assessment of Moscow City Department of Healthcare

Email: 08@gmail.com
candidate of medical sciences , lead researcher of the scientific-clinical department of the State Budgetary Institution «Scientific-Practical Center for Clinical Trials and Healthcare Technology Assessment of Moscow City Department of Healthcare», 121096, Moscow, Russian Federation 121096, Moscow, Russian Federation

A. Zavyalov

Scientific-Practical Center for Clinical Trials and Healthcare Technology Assessment of Moscow City Department of Healthcare

121096, Moscow, Russian Federation

A. Govorov

A.I. Evdakimov Moscow State University of Medicine and Dentistry

127473, Moscow, Russian Federation 127473, г. Москва

K. Kokushkin

Scientific-Practical Center for Clinical Trials and Healthcare Technology Assessment of Moscow City Department of Healthcare

121096, Moscow, Russian Federation

M. Davidovskaya

Scientific-Practical Center for Clinical Trials and Healthcare Technology Assessment of Moscow City Department of Healthcare; N.I. Pirogov Russian National Research Medical University

121096, Moscow, Russian Federation; 117997, Moscow, Russian Fedration

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