Androgeenreceptorremming tegen prostaatkanker

Nieuwe middelen, maar voor welke patiënt?
Commentaar
04-12-2019
André N. Vis en R.J.A. (Jeroen) van Moorselaar

Hormonale therapie, oftewel androgeendeprivatietherapie (ADT) is een van de pijlers in de behandeling van patiënten met een prostaatcarcinoom. Er zijn wereldwijd echter belangrijke verschillen in behandelrichtlijnen over wat het beste moment is om met ADT te beginnen. Onlangs verschenen in het New England Journal of Medicine de resultaten van het onderzoek naar een nieuwe androgeenreceptorantagonist (ARA), darolutamide. Het is de vraag of deze resultaten noemenswaardige consequenties hebben voor de huidige klinische praktijk in Nederland.

Androgen receptor inhibitors in prostate cancer: new drugs, but for which patient?

The results of a recent randomised phase 3 clinical trial show that the androgen receptor antagonist darolutamide improves metastasis-free survival in men with non-metastatic, castration-resistant prostate cancer, compared with placebo. The trial included 1509 men with a prostate-specific antigen doubling time of 10 months or less. Non-metastatic disease was defined as the absence of metastases, using conventional imaging rather than the substantially more sensitive PSMA scans. The effect of darolutamide is similar to that of other androgen inhibitors, such as apalutamide and enzalutamide. The value of the current trial to Dutch clinical practice is limited, as the number of patients with non-metastatic, castration-resistant prostate cancer is low due to the increased use of PSMA scans and the reluctance of urologists to start androgen-deprivation therapy in the absence of metastatic disease.

Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.