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Current Oncology Reports Mar 2023Multimodality therapy including radical prostatectomy, radiation therapy, and hormone therapy are frequently deployed in the management of localized prostate cancer. We... (Review)
Review
PURPOSE OF REVIEW
Multimodality therapy including radical prostatectomy, radiation therapy, and hormone therapy are frequently deployed in the management of localized prostate cancer. We sought to perform a critical appraisal of the most contemporary literature focusing on the multimodality management of localized prostate cancer.
RECENT FINDINGS
Men who are ideal candidates for multimodality therapy include those with unfavorable intermediate-risk disease, high-risk disease, and very high-risk disease. Enhancements in both systemic agents (including second-generation antiandrogens) as well as localized therapies (such as stereotactic body radiotherapy and brachytherapy) are refining the optimal balance between the use of systemic and local therapies for localized prostate cancer. Genomic predictors are emerging as critical tools for more precisely allocating treatment intensification with multimodality therapies as well as treatment de-intensification. Close collaboration among medical oncologists, surgeons, and radiation oncologists will be critical for coordinating evidence-based multimodality therapies when clearly indicated and for supporting shared decision-making in areas where the evidence is mixed.
Topics: Male; Humans; Prostatic Neoplasms; Brachytherapy; Combined Modality Therapy; Prostatectomy; Androgen Antagonists
PubMed: 36723856
DOI: 10.1007/s11912-023-01374-9 -
Urology Practice Nov 2023Hormonal therapy is the standard of care in prostate cancer treatment. The approval of the first oral androgen deprivation therapy, relugolix, to treat prostate cancer... (Review)
Review
INTRODUCTION
Hormonal therapy is the standard of care in prostate cancer treatment. The approval of the first oral androgen deprivation therapy, relugolix, to treat prostate cancer patients provides an opportunity to review adherence to oral and injectable/implantable hormonal therapies to aid patients and physicians in making informed decisions.
METHODS
A PubMed search for available literature on adherence to hormonal therapy in prostate cancer was conducted, including published data on relugolix.
RESULTS
Adherence to oral antiandrogen therapy was above 90% by medication possession ratio in several studies worldwide and from 75% to 91% by proportion of days covered. For injectable/implantable androgen deprivation therapy, adherence to treatment ranged from 71% to 95%. In general, 60% and 29% of injections were reported to be delayed by more than 1 week and 2 weeks, respectively, with some patients experiencing testosterone increases (tests above 50 ng/dL). Although real-world data on adherence to relugolix are currently unavailable, pharmacokinetic/pharmacodynamics models demonstrated that, if necessary, treatment interruption up to 7 days would still maintain testosterone suppression levels.
CONCLUSIONS
In general, adherence to hormonal therapy is high in prostate cancer. Studies revealed that adherence to injectable androgen deprivation therapy dosing schedules is important to maintain castrate levels. Pharmacokinetic/pharmacodynamics models showed that relugolix treatment interruption up to 7 days had minimal impact on testosterone suppression levels.
Topics: Male; Humans; Prostatic Neoplasms; Androgen Antagonists; Androgens; Prostate-Specific Antigen; Antineoplastic Agents, Hormonal; Testosterone
PubMed: 37647139
DOI: 10.1097/UPJ.0000000000000445 -
Drugs Feb 2023Rezvilutamide () is an oral, second-generation androgen receptor antagonist being developed by Jiangsu Hengrui Medicine Co., Ltd for the treatment of prostate cancer. In... (Review)
Review
Rezvilutamide () is an oral, second-generation androgen receptor antagonist being developed by Jiangsu Hengrui Medicine Co., Ltd for the treatment of prostate cancer. In June 2022, rezvilutamide was approved in China for the treatment of patients with metastatic hormone-sensitive prostate cancer (mHSPC) with high tumour burden. This article summarizes the milestones in the development of rezvilutamide leading to this first approval for patients with prostate cancer.
Topics: Male; Humans; Androgen Antagonists; Prostatic Neoplasms; Androgen Receptor Antagonists; China; Drug Approval
PubMed: 36630077
DOI: 10.1007/s40265-022-01831-y -
Clinical Advances in Hematology &... Jun 2023Prostate cancer is the most frequently diagnosed non-skin cancer and the second leading cause of cancer-related mortality in men in the United States. Over the past... (Review)
Review
Prostate cancer is the most frequently diagnosed non-skin cancer and the second leading cause of cancer-related mortality in men in the United States. Over the past decade, the treatment landscape for advanced prostate cancer has rapidly shifted. For decades, androgen deprivation therapy has been the cornerstone of systemic treatment for patients with metastatic hormone-sensitive prostate cancer (mHSPC). However, more recently, we have seen the emergence of doublet and triplet combinations in the mHSPC setting. At the same time, there is an expanding list of treatments for patients with metastatic castration-resistant prostate cancer (mCRPC), including hormonal treatments, chemotherapy, immunotherapy, bone-targeted agents, radioligand therapy, and targeted therapy. The shifting of the treatment landscape for advanced prostate cancer has raised many questions regarding patient selection, therapy choice, and sequencing of different approved agents, particularly in the mCRPC setting with the earlier use of chemotherapy and androgen receptor signaling inhibitors. Since then, multiple trials have been conducted to improve the management of mHSPC and delay its progression to mCRPC. This review article discusses various clinical trials that focus on novel therapeutic targets for prostate cancer and how the initiation of newer clinical trials has affected older therapies and trials.
Topics: Male; Humans; Prostatic Neoplasms, Castration-Resistant; Androgen Antagonists; Drug Approval; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols
PubMed: 37530638
DOI: No ID Found -
Current Opinion in Urology May 2024To summarize the recent findings on the subject of metastasis-directed therapy (MDT) in the treatment of oligometastatic prostate cancer (omPCa). (Review)
Review Meta-Analysis
PURPOSE OF REVIEW
To summarize the recent findings on the subject of metastasis-directed therapy (MDT) in the treatment of oligometastatic prostate cancer (omPCa).
RECENT FINDINGS
Evidence from two randomized clinical trials (RCTs) and a meta-analysis show favorable toxicity profiles, and the potential to delay androgen-deprivation therapy (ADT) for up to two years in nearly half of patients with metachronous hormone-sensitive omPCa. Another RCT showed promising results of MDT as treatment-escalation method combined with androgen receptor signaling inhibitors (ARSI) in first-line treatment for castration-resistant omPCa.Surveys by radiation oncologists and consensus guidelines advocate for MDT across various omPCa scenarios. Multiple single-arm trials present encouraging results; however, the evidence for the benefit of MDT is still weak requiring further investigation to assess its impact on pivotal endpoints, such as survival and quality of life.
SUMMARY
MDT is a promising approach in omPCa, and can be used to defer ADT in newly diagnosed metachronous omPCa patients, or to add to ARSI treatment at first diagnosis of castration-resistance. Ongoing prospective trials are needed to guide its optimal utilization in other settings, and patients should be informed about the evolving landscape of systemic therapies with proven survival benefits alongside MDT options.
Topics: Male; Humans; Prostatic Neoplasms; Antineoplastic Agents, Hormonal; Androgen Antagonists
PubMed: 38426229
DOI: 10.1097/MOU.0000000000001169 -
The Prostate May 2022Bipolar androgen therapy (BAT) is a new treatment concept for men whose prostate cancer has become resistant to standard hormone-blocking therapy. Over the past decade,... (Review)
Review
Bipolar androgen therapy (BAT) is a new treatment concept for men whose prostate cancer has become resistant to standard hormone-blocking therapy. Over the past decade, we have performed a series of clinical studies testing BAT in asymptomatic men with castration-resistant prostate cancer. The key findings from these clinical studies are that BAT (a) can be safely administered to asymptomatic patients with metastatic castrate-resistant prostate cancer; (b) does not produce symptomatic disease progression; (c) produces sustained prostate-specific antigen and objective responses in 30%-40% of patients; and (d) can resensitize and prolong response to subsequent antiandrogen therapy. The concept of BAT has generated significant interest from men with prostate cancer, their families, and their physicians. Here we provide a "Patient's Guide" that answers questions about BAT in a form that is accessible to patients, their families, and physicians. Our goal is to provide information to help patients make the most informed decisions they can regarding their prostate cancer treatment.
Topics: Androgen Antagonists; Androgens; Disease Progression; Humans; Male; Prostatic Neoplasms; Prostatic Neoplasms, Castration-Resistant; Testosterone
PubMed: 35357024
DOI: 10.1002/pros.24328 -
Actas Dermo-sifiliograficas Feb 2021Researchers the world over are working to find the treatments needed to reduce the negative effects of coronavirus disease 2019 (COVID-19) and improve the current... (Review)
Review
Researchers the world over are working to find the treatments needed to reduce the negative effects of coronavirus disease 2019 (COVID-19) and improve the current prognosis of patients. Several drugs that are often used in dermatology are among the potentially useful treatments: ivermectin, antiandrogenic agents, melatonin, and the antimalarial drugs chloroquine and hydroxychloroquine. These and other agents, some of which have proven controversial, are being scrutinized by the scientific community. We briefly review the aforementioned dermatologic drugs and describe the most recent findings relevant to their use against COVID-19.
Topics: Androgen Antagonists; Antimalarials; Antioxidants; Antiparasitic Agents; COVID-19; Chloroquine; Cinchona; Humans; Hydroxychloroquine; Ivermectin; Melatonin; SARS-CoV-2; Virus Internalization; COVID-19 Drug Treatment
PubMed: 33045209
DOI: 10.1016/j.ad.2020.09.004 -
American Society of Clinical Oncology... Apr 2022Biochemical recurrence develops in almost one-third of men with prostate cancer after treatment with local therapy. There are numerous options for management, including... (Review)
Review
Biochemical recurrence develops in almost one-third of men with prostate cancer after treatment with local therapy. There are numerous options for management, including surveillance, salvage radiation, androgen deprivation therapy (ADT), and clinical trials. This article reviews the current approaches to radiation therapy, ADT, and molecular imaging in men with biochemically recurrent prostate cancer. First, radiation therapy, including selection of field, dose, and use of concurrent antiandrogen therapy, is reviewed. Next, molecular imaging is addressed, including prostate-specific membrane antigen PET imaging and its increased sensitivity in identifying sites of disease. Finally, the factors associated with starting ADT are explored, and the data supporting intermittent over continuous ADT are reviewed. Lastly, the use of prostate-specific membrane antigen PET imaging and its potential role influencing therapy are discussed.
Topics: Androgen Antagonists; Combined Modality Therapy; Humans; Male; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Salvage Therapy
PubMed: 35503984
DOI: 10.1200/EDBK_351033 -
International Journal of Molecular... Dec 2022Hidradenitis suppurativa (HS) is a chronic inflammatory disease manifesting in inverse body regions. In a systematic review, the role of hormones in HS will be presented... (Review)
Review
Hidradenitis suppurativa (HS) is a chronic inflammatory disease manifesting in inverse body regions. In a systematic review, the role of hormones in HS will be presented to better understand the pathomechanisms of HS. The review is based on the PRISMA criteria. Systematic research was carried out using keywords. Subsequently, the data were analyzed based on the clinical response and other relevant information. The main focus of our systematic review was on HS manifestation, exacerbation, sex hormones, antiandrogen therapy, thyroid function, polycystic ovary syndrome, insulin resistance, and adipokines. In HS, there appears to be a dysregulated adipokine release that is shifted towards pro-inflammatory adipokines. Insulin resistance is significantly more common in HS than in healthy patients regardless of BMI, age, and gender. Insulin resistance in HS patients leads to further cardiovascular disease. The mechanism of insulin resistance and role of adipokines should be investigated in future studies to better provide the pathomechanisms of HS. The role of androgens seems to be important in a certain subgroup of female patients. Anti-androgenic therapy can be useful and helpful in some patients. However, further studies are needed to better understand the hormonal relationship in HS.
Topics: Humans; Female; Insulin Resistance; Hidradenitis Suppurativa; Androgens; Gonadal Steroid Hormones; Androgen Antagonists
PubMed: 36499573
DOI: 10.3390/ijms232315250 -
International Journal of Molecular... Dec 2023Breast cancer subtypes expressing hormone receptors (HR+ BCa) have a good prognosis and respond to first-line endocrine therapy (ET). However, the majority of HR+ BCa... (Review)
Review
Breast cancer subtypes expressing hormone receptors (HR+ BCa) have a good prognosis and respond to first-line endocrine therapy (ET). However, the majority of HR+ BCa patients exhibit intrinsic or acquired ET resistance (ET-R) and rapid onset of incurable metastatic BCa. With the failure of conventional ET, limited targeted therapy exists for ET-R HR+ BCa patients. The androgen receptor (AR) in HR-negative BCa subtypes is emerging as an attractive alternative target for therapy. The AR drives Luminal AR (LAR) triple-negative breast cancer progression, and LAR patients consistently exhibit positive clinical benefits with AR antagonists in clinical trials. In contrast, the function of the AR in HR+ BCa is more conflicting. AR in HR+ BCa correlates with a favorable prognosis, and yet, the AR supports the development of ET-R BCa. While AR antagonists were ineffective, ongoing clinical trials with a selective AR modulator have shown promise for HR+ BCa patients. To understand the incongruent actions of ARs in HR+ BCa, the current review discusses how the structure and post-translational modification impact AR function. Additionally, completed and ongoing clinical trials with FDA-approved AR-targeting agents for BCa are presented. Finally, we identify promising investigational small molecules and chimera drugs for future HR+ BCa therapy.
Topics: Humans; Receptors, Androgen; Androgens; Triple Negative Breast Neoplasms; Androgen Antagonists; Androgen Receptor Antagonists
PubMed: 38203649
DOI: 10.3390/ijms25010476