1、抑那通治疗前列腺癌的新进展,北京大学第三医院 黄 毅,AUA(2010)内分泌治疗新进展,Radiotherapy combined with androgen deprivation vs. androgen deprivation alone in clinically locally advanced prostate caner in a multicenter randomised phase III studyNicolas Mottet, France.,AUA(2010)内分泌治疗新进展,INTRODUCTION AND OBJECTIVESIn locally advance
2、d disease, the combination of radiotherapy (RT) and androgen deprivation (ADT) is superior to RT alone.But ADT with an analogue has never been compared to combined modality.We report a phase III randomised trial in locally advanced PCa, comparing a combined modality and ADT only.,AUA(2010)内分泌治疗新进展,M
3、ETHODSIn this French multicenter, open, randomised trial, patients less than 80 years, with histologically confirmed PCa, T3-4, or pT3 (biopsy) N0M0 were included.They were centrally randomised in 2 parallel groups to either ADT alone (leuprorelin 11.25 mg SR,1 sc injection every 3 months for 3 year
4、s or the same ADT combined with RT starting within 3 months over 7 weeks.,AUA(2010)内分泌治疗新进展,RESULTS,AUA(2010)内分泌治疗新进展,Prevalence of metabolic syndrome in prostate cancer patients under androgen deprivation therapy: interim results of a case-control study.Jorge Ropero, Barcelone, Spain.,AUA(2010)内分泌治
5、疗新进展,INTRODUCTION AND OBJECTIVESCardiovascular mortality is the most important cause of death in patients with prostate cancer (PC).The development of metabolic syndrome (MS) in patients undergoing androgen deprivation therapy (ADT) has been related with this increase in mortality rate. The aim of t
6、his study has been to confirm the hypothesis that ADT increases the prevalence of MS.,AUA(2010)内分泌治疗新进展,METHODSA group of 157 patients were enrolled in this interim analysis of a prospective case control study. 53 PC patients under ADT during a mean time of 52 months (6 to 252) and 104 age matched c
7、ontrols evaluated at the time of prostate biopsy (52 with cancer and 52 without) were included.,AUA(2010)内分泌治疗新进展,METHODSMS was analyzed according the ATPIII panel criteria:Fasting plasma glucose level 110 mg/dL serum triglyceride level 150 mg/dL serum high-density lipoprotein level102 cm Blood pres
8、sure of 130/85 mmHg.,AUA(2010)内分泌治疗新进展,RESULTSMS was diagnosed in 27 of the 53 patients subjected to ADT (51.9%) while it was detected in 35 of the 105 age-matched controls (33.3%), p = 0.020. However the prevalence of MS was 35.8% (19/53) in men without PC and 30.8% (16/52) in men with PC, p=0.365.
9、,AUA(2010)内分泌治疗新进展,CONCLUSIONAlthough the limited number cases and controls included in this interim analysis, a significant increase in the prevalence of MS was observed in PC patients subjected to ADT.,AUA(2010)内分泌治疗新进展,Metabolic change after androgen deprivation therapy in Korean men with prostat
10、e cancerChang Hoo Park, Korea,AUA(2010)内分泌治疗新进展,INTRODUCTION AND OBJECTIVES In men with prostate cancer, Androgen deprivation therapy shows a variety well recognized metabolic alteration.To better characterize the metabolic effects of androgen deprivation therapy in Korean men, we evaluated the chan
11、ges in fat thickness, bone mineral density (BMD), body mass index (BMI), and levels of hemoglobin (Hb) and cholesterol. We also compared them with data from healthy subjects.,AUA(2010)内分泌治疗新进展,METHODSFrom December 2002 to December 2008, 148 Korean men treated with leuprolide depot and bicalutamide f
12、or prostate cancer and 100 healthy subjects were investigated included change from baseline to month 12 in fat thickness, bone mineral density (BMD), body mass index (BMI), and levels of hemoglobin (Hb) and cholesterol.,AUA(2010)内分泌治疗新进展,RESULTS,There are no significant changes in hemoglobin and cho
13、lesterol levels.,AUA(2010)内分泌治疗新进展,CONCLUSIONOur results show that Korean men with prostate cancer have increased abdominal subcutaneous fat and BMI and have decreased BMD during androgen deprivation therapy.These increases the risk of bone fracture and complication related obesity. Therefore, BMD w
14、ill be checked periodically and carry out exercise program to prevention obesity during androgen deprivation therapy.,AUA(2010)内分泌治疗新进展,Sarcopenia in men receiving androgen deprivation therapy for prostate cancer: a prospective 3-year study.Matthew R. Smith,CA.,AUA(2010)内分泌治疗新进展,INTRODUCTION AND OBJ
15、ECTIVESAndrogen deprivation therapy (ADT) for prostate cancer decreases bone mineral density and increases fracture risk.Studies with limited sample size and observational periods have reported that ADT is also associated with sarcopenia or loss of muscle (lean body mass, LBM). We now report the pro
16、spective changes in LBM in a subset of men from that study.,AUA(2010)内分泌治疗新进展,METHODSMen undergoing ADT for nonmetastatic prostate cancer at 38 centers in North America were randomized to denosumab or placebo.A total of 248 subjects (130 denosumab, 118 placebo) with a baseline and with at least 1 on
17、-study LBM result were considered evaluable and included in this analysis.,AUA(2010)内分泌治疗新进展,METHODSSubjects were stratified at baseline by age (6 months). LBM was measured by total body dual-energy x-ray absorptiometry at baseline and at 12, 24, and 36 months.,AUA(2010)内分泌治疗新进展,RESULTSFrom baseline
18、 to month 12, mean LBM decreased significantly by 1.0% (p=.0004). Significant decreases in LBM were also observed at month 24 (2.1%, p.0001) and month 36 (2.4%, p.0001).,AUA(2010)内分泌治疗新进展,RESULTSMen aged 70 years(n=127) had significantly greater changes in LBM at all measured time points. At 36 mont
19、hs, LBM decreased by 2.8% in men aged 70 years compared with a decrease of 0.9% in younger men (p=0.035).,AUA(2010)内分泌治疗新进展,CONCLUSIONThis is the largest and longest prospective study undertaken to describe the natural history of muscle loss in men undergoing ADT therapy for prostate cancer. LBM sig
20、nificantly decreased at 12, 24, and 36 months. Decreases in LBM were greatest in older men and in those who had short duration of ADT at study entry.,AUA(2010)内分泌治疗新进展,Recovery of testosterone and PSA after cessation of long term luteinizing hormone releasing hormone agonist (LHRH) therapy for prost
21、ate cancer: a prospective trial.Matthew McIntyre, Charleston, SC,AUA(2010)内分泌治疗新进展,INTRODUCTION AND OBJECTIVESThe use of hormonal manipulation in the treatment of prostate cancer has been an option since the time of Huggins initial description. However, many questions remain regarding timing of init
22、iation, and length of treatment interval for medically induced castration.,AUA(2010)内分泌治疗新进展,INTRODUCTION AND OBJECTIVESThe effects of long term LHRH agonist on the hypothymalic pituitary gonadal axis are also not completely understood.We sought to examine the effects of long term LHRH agonist on re
23、covery of testosterone and PSA.,AUA(2010)内分泌治疗新进展,METHODSHormonal ablation was discontinued and serial testosterone and PSA measurements were obtained on a three monthly basis. Patients were counseled regarding restarting hormonal therapy if 2 consecutive rises in PSA were observed. Patients were al
24、lowed to stay off hormones and on study if they desired.,AUA(2010)内分泌治疗新进展,METHODSWe organized a prospective trial examining men at the Veterans Administration Hospital who had been on at least 48 months of an LHRH agonist. Other inclusion criteria were that PSA be less than 3ng/ml, and not rising f
25、or the 2 consecutive values prior to discontinuing hormones.,AUA(2010)内分泌治疗新进展,RESULTSNineteen patients were enrolled in the study between 2007 and 2008. The mean age was 75 years. The mean duration of hormonal therapy was 88 months.,AUA(2010)内分泌治疗新进展,RESULTSTen (53%) patients were on hormones for b
26、iochemical recurrence； Two (10%) for metastatic disease； Seven (36%) as primary therapy.,AUA(2010)内分泌治疗新进展,RESULTSEleven (58%) patients had 2 consecutive rises in PSA;The mean time to see two consecutive rises was 11 months.,AUA(2010)内分泌治疗新进展,RESULTS The mean time off therapy prior to a rise in PSA
27、0.1ng/ml above base line for all patients and those with 2 consecutive rises was 15.4 and 9.5 months respectively. The mean base line PSA, mean PSA at one, and at two years off therapy was 0.3ng/ml, 1.1ng/ml, and 5ng/ml respectively. Mean testosterone at base line, one, and two years off therapy was
28、 13.9ng/ml, 76ng/ml, and 150.6ng/ml respectively.,AUA(2010)内分泌治疗新进展,RESULTS Twelve (63%) patients had recovery of testosterone above 50ng/dl.Four (21%) patients remained castrate off therapy a mean of 20 months. The mean time to testosterone recovery was 12.8 months.Two (10.5%) patients in the study
29、 have died. One death was attributed to prostate cancer.,AUA(2010)内分泌治疗新进展,CONCLUSIONThe recovery of testosterone and significant elevations of PSA after long term LHRH agonist therapy is significantly delayed in most patients.This helps to support the concept of intermittent androgen ablation which
30、 has benefits in quality of life and reduced cost of therapy.,Data on file,手术去势的副作用 增加心血管疾病和糖尿病发病率,Data on file,手术去势的副作用 增加骨折发病率,抑那通通过抑制雄性激素的作用而抑制大白鼠前列腺肿瘤的增殖,醋酸亮丙瑞林水溶液 0.333mg/kg/日（1日1次投药),醋酸亮丙瑞林水溶液 0.333mg/kg/日（1日2次投药),抑那通 相当于0.333mg/kg/日（1月1次投药),阉割,肿瘤移植后的天数,肿 瘤 体 积(cm),对照,醋酸亮丙瑞林水溶液 1mg/kg/日（1日1次投药
31、),抑那通与睾丸切除术抗肿瘤作用比较,抑那通治疗前列腺癌的综合效果,抑那通治疗前列腺癌各病灶的疗效,抑那通改善前列腺癌各种症状的效果明显,抑那通治疗前列腺癌从起效到部分缓解的时间,间歇疗法与持续疗法患者生存率相当,Data on file,抑那通间歇疗法显著降低前列腺体积,第1周期,第2周期,前列腺体积变化比例(%),Bruchovsky N, et al. Cancer.2006 Jul 15;107(2):389-95,抑那通间歇疗法迅速降低PSA值,到达PSA最低值所需时间(月),Higano CS, et al. Urology.1996 Nov;48(5):800-4,间歇疗法减少骨质丢失，降低副反应发生率,Uif Tunn 2007 Bju International 99,supplement 1,19-22,Data on file,间歇期雄激素明显恢复，可改善患者生活质量,间歇疗法有利于患者性功能恢复,N.A.Spry,et al European Journal of Cancer 42(2006):1083-1092,间歇期暂停用药，大幅度降低治疗成本,总 结,有效治疗前列腺癌患者生存率与持续疗法相当与去势疗法相比，副作用显著降低改善性功能，提高生活质量降低治疗成本,抑那通间歇疗法优势突出,抑那通3.75mg预充式注射器,现有剂型,上市新剂型,谢谢！,
