Antiandrogen treatments in locally advanced prostate cancer: are they all the same?

@article{Gillatt2006AntiandrogenTI,
  title={Antiandrogen treatments in locally advanced prostate cancer: are they all the same?},
  author={David Gillatt},
  journal={Journal of Cancer Research and Clinical Oncology},
  year={2006},
  volume={132},
  pages={17-26}
}
  • D. Gillatt
  • Published 15 July 2006
  • Medicine, Biology
  • Journal of Cancer Research and Clinical Oncology
PurposeThe objectives are to review the published literature and to evaluate the weight of evidence for clinical effectiveness, safety, and tolerability of the currently available antiandrogens in the treatment of locally advanced prostate cancer. This article covers efficacy as monotherapy relative to castration and as adjuvant to radiotherapy and radical prostatectomy as well as adverse-effect and quality-of-life data.MethodsThe current literature from online databases between 1986 and the… 

Safety of antiandrogen therapy for treating prostate cancer

This review elucidates the safety profile of antiandrogens, in particular focusing on the tolerability profile of each drug either when employed in combination with castration or as monotherapy, in hormone-naive or in castration-resistant patients.

Treatment of bicalutamide-induced breast events

  • P. Sieber
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  • 2007
An ongoing clinical trial using toremifene to prevent morphometric vertebral fractures in men undergoing medical and/or surgical castration will provide some additional data on the effects of selective estrogen receptor modulators in men with prostate cancer.

Oncological outcomes of hormonal therapy with a gonadotropin-releasing hormone agonist combined with a steroidal or non-steroidal antiandrogen in patients with prostate cancer.

CAB therapy using chlormadinone led to a significantly poorer survival outcome versus the use of bicalutamide, however, because this survival trend was not observed in M0 cases, chlormanadinone may still be an option for CAB therapy, depending on clinical stage and the severity of adverse effects, such as hot flashes.

[Hormonal treatment in prostate cancer].

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There is no conclusive evidence that HT after RP will prolong survival or reduce morbidity, but non-traditional approaches, such as intermittent androgen deprivation, non-steroidal anti-androgen, are investigated and may be acceptable options.

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The current state of anti-androgen therapy, mainly for CRPC, is detailed, with major emphasis on the most potent and promising compounds under development.

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A role has emerged for systemic chemotherapy after the demonstration of a small but significant survival benefit for taxane-based chemotherapy in the two landmark studies, TAX-327 and SWOG-9916 [3, 4].

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The current best status of anti-androgen clinical trials, the potential for novel combination therapies and recent advances in the development of novel epigenetic targeted therapies that may be relevant to prevent or reverse disease progression in patients with advanced CRPC are summarized.
...

References

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The role of antiandrogen monotherapy in the treatment of prostate cancer

Current data are inadequate to draw conclusions on the comparative efficacy of flutamide and castration, while nilutamide is not licensed for monotherapy, and bicalutamide has a more favourable side‐effect profile than the other antiandrogens and is more likely to promote compliance.

Nilutamide: An Antiandrogen for the Treatment of Prostate Cancer

Nilutamide does not appear to represent a major advance in the treatment of advanced prostate cancer and appears to be somewhat inferior to both flutamide and bicalutamide with regard to adverse effects.

Antiandrogens: a summary review of pharmacodynamic properties and tolerability in prostate cancer therapy.

The bicalutamide, due to its better tolerability profile, together with its once-daily oral administration regimen, could be considered the antiandrogen of first choice in the treatment of prostatic cancer.

Flutamide versus orchidectomy in the treatment of metastatic prostate carcinoma.

It is shown that in spite of a constant elevation of serum testosterone (25% over baseline) flutamide 250 mg tid may be a reasonable alternative to castration in highly selected patients with well to moderately differentiated low volume metastatic prostate cancer and wishing to avoid the side effects of androgen deprivation.

Nonsteroidal antiandrogens: a therapeutic option for patients with advanced prostate cancer who wish to retain sexual interest and function

In the absence of sexual interest, the treatment of sexual dysfunction becomes less relevant and therefore hormonal treatments for advanced prostate cancer which spare sexual interest are needed.

Double-blind, randomized study of primary hormonal treatment of stage D2 prostate carcinoma: flutamide versus diethylstilbestrol.

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As the primary hormonal therapy for stage D2 prostate cancer, DES caused more serious cardiovascular or thromboembolic complications than flutamide, andFlutamide was not as active an initial agent as DES, however, the effectiveness of flutamia in conjunction with other agents compared with DES remains undetermined.

Bicalutamide 150 mg in addition to standard care in patients with localized or locally advanced prostate cancer: results from the second analysis of the early prostate cancer program at median followup of 5.4 years.

It is confirmed that bicalutamide provides benefit in patients with locally advanced disease and early or adjuvant hormonal therapy for patients at low risk of disease progression, such as those with localized disease, is not appropriate.

Bicalutamide monotherapy versus flutamide plus goserelin in prostate cancer patients: results of an Italian Prostate Cancer Project study.

Bicalutamide monotherapy yielded comparable results relative to standard treatment with MAB, induced fewer side effects, and produced a better QOL.
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