2019년 6월 26일 (수) 07:05에 Sjlee님의 편집

2019-06-26T07:05:52Z

Sjlee: 새 문서: === Androgen deprivation therapy[편집 | 원본 편집] === - Basics of hormonal control of the prostate - Therapeutic approaches to androgen deprivation therapy 1) Bilateral or...

2019-06-26T07:05:06Z

새 문서: === Androgen deprivation therapy[편집 | 원본 편집] === - Basics of hormonal control of the prostate - Therapeutic approaches to androgen deprivation therapy 1) Bilateral or...

새 문서

=== Androgen deprivation therapy[편집 | 원본 편집] ===
- Basics of hormonal control of the prostate

- Therapeutic approaches to androgen deprivation therapy

1) Bilateral orchiectomy
: : Within 24hours of surgical castration, testosterone levels are reduced by more than 90%
2) Inhibition of LHRH
: (1) LHRH agonist
: synthetic analogs of native LHRH
: initial exposure to agonists of LHRH results in a flare of LH testosterone levels
: : known as the ‘testosterone surge’ or ‘flare up’ phenomenon (begins within 2-3days of the first injection and lasts through approximately the first week of therapy)
: : result in a severe, life-threatening exacerbation of symptoms
: → co-administration of an antiandrogen (for only 21-28 days)
: Goserelin acetate (Zoladex): 3.6mg sc monthly
: Leuprorelin acetate (Leuplin): 3.75mg sc monthly
: Leuprolide acetate: 7.5mg sc monthly
3) Antiandrogens
: Compete with testosterone and DHT for binding sites on their receptors in the prostate cell nucleus: promoting apoptosis and inhibiting prostate cancer growth
: - Steroidal antiandrogens
: : Cyproterone Acetate, Megesterol acetate, medroxyprogesterone acetate
: - Non-steroidal or pure antiandrogen
: : Flutamide (250mg tid), bicalutamide (50mg po daily), nilutamide (150mg daily)
4) Antiandrogen withdrawal phenomenon
: 정의: experience a decline in PSA level, objective
: responses with the withdrawal of the antiandrogen from the combination with LHRH agonist
: - Declines in PSA level are seen
: → within 4weeks with flutamide withdrawal
: → within 6weeks with bicalutamide, nilutamide withdrawal
: - Declines in PSA level of more than 50% (15-30%), and median duration of 3.5-5months

=== Castration resistant prostate cancer[편집 | 원본 편집] ===
1) CRPC without Symptom or minimal Symptom
: (1) Observation
: (2) 2nd hormonal Tx
: - Ketoconazole: 200mg tid+prednisolone 5mg bid
:: 그외 Alternative antiandrogen, High dose antiandrogen, Estrogen, Glucocorticoid 등이 있음.
2) CRPC with Symptom
: (1) Docetaxel+prednisolone
:: Docetaxel 75mg/m2+P/S 200ml IV for 1hr Day1+PRD 5mg bid po q 3wks
:: RR: 70% (PR: 38%, CR: 32%), median survival: 12.7 mo response rate of reduction in PSA 45%
:: - Ref) NEJM 2004;351:1502-1512
<nowiki>**</nowiki> Docetaxel 투여시 전처치 및 주의사항
: - Prevention of hypersensitive reaction
1) dexamethasone 20mg iv before 30min of chemotherapy(Day1) 2) dexamethasone (8mg orally twice daily, Day 2-3)
: steroid 전처치: hypersensitivity 감소, fluid retention 감소, asthenia 감소
3) pheniramine 1x iv

4) ranitidine 50mg iv

- Dose reduction from toxicity

1) 20% dose reduction:
: prolonged grade 4 neutropenia (>7days)
: grade 4 thrombocytopenia
: grade ≥2 liver toxicity
: grade ≥3 diarrhea
: grade ≥3 cutaneous toxicity
2) Discontinue
: grade > 2 renal toxicity: Clcr < 60ml/min
: grade 3 liver toxicity
: grade ≥ 3 neuropathy
: grade 4 cutaneous toxicity
: grade 3 anaphylactoid reaction
<nowiki>*</nowiki> Docetaxel chemoTx 예시 (OPD)
: 1. Prehydration P/S 500cc (300cc/hr)
: 2. dexamethasone 10mg iv
: 3. metoclopramide 10mg iv
: 4. chemo
:: Docetaxel 75mg/m2+P/S 200cc (200cc/hr)
: 5. posthydration P/S 500cc (300cc/hr)
: 6. med) solondo (prednisolone) 5mg bid for 21days PRN med
: (2) Mitoxantrone+prednisolone (이 regimen은 pain palliation이 목적임.)
:: Mitoxantrone (Mitron) 12mg/m2+P/S 100ml IV Day1+PRD 5mg BID for 21days
:: Ref> JCO 1996;14:1756
<nowiki>**</nowiki> 새로운 약제들

1) Abiraterone acetate, androgen synthesis inhibitor (CYP 17 inhibitor)- CRPC, docetaxel 사용 전, 혹은 후 Abiraterone acetate 1,000mg once a day+prednisolone 5mg bid
: OS: 14.8 month PFS: 5.6 month
: Ref> NEJM 2011;364:1995, 2013;368;138
2) Enzalutamide (MDV 3,100), New androgen receptor inhibitors - CRPC, docetaxel fail 후에 Enzalutamide 160mg once a day
: OS: 18.4 month
: Ref> NEJM 2012;367:1187
3) Cabazitaxel- CRPC, docetaxel fail 후
: Cabazitaxel 25mg/m2 iv over 1hr every 3weeks+prednisolone 5mg bid
: OS: 15.1 month, PFS: 2.8 month
: Ref> Lancet 2010;376:1147
<nowiki>**</nowiki> Spinal cord compression
: Dexamethsone 10mg loading after 4mg q 6hr+RT

@@ 1번째 줄: / 1번째 줄: @@
-=== Androgen deprivation therapy[편집 | 원본 편집] ===
+=== Androgen deprivation therapy ===
 - Basics of hormonal control of the prostate
@@ 31번째 줄: / 31번째 줄: @@
 : - Declines in PSA level of more than 50% (15-30%), and median duration of 3.5-5months
-=== Castration resistant prostate cancer[편집 | 원본 편집] ===
+=== Castration resistant prostate cancer ===
 ) CRPC without Symptom or minimal Symptom
 : (1) Observation

Metastatic Prostate Cancer - 편집 역사

2019년 6월 26일 (수) 07:05에 Sjlee님의 편집

Sjlee: 새 문서: === Androgen deprivation therapy[편집 | 원본 편집] === - Basics of hormonal control of the prostate - Therapeutic approaches to androgen deprivation therapy 1) Bilateral or...