RESUMO
Prostate cancer is the most common solid organ cancer affecting the male population. Men with metastatic prostate cancer treated with androgen ablation therapy often respond rapidly, with improvement in bone pain and decreases in serum prostate-specific antigen. However, almost all patients progress to the castration-resistant state and abiraterone acetate was the last treatment available with proven survival benefit. Enzalutamide (formerly MDV3100) is an androgen receptor signaling inhibitor that has been shown to improve survival in men with metastatic castration-resistant prostate cancer previously treated with chemotherapy. In this article we discuss the characteristics of enzalutamide and provide a review of its clinical development.
Assuntos
Antagonistas de Androgênios/uso terapêutico , Antineoplásicos/uso terapêutico , Feniltioidantoína/análogos & derivados , Neoplasias da Próstata/tratamento farmacológico , Antagonistas de Androgênios/efeitos adversos , Antagonistas de Androgênios/farmacocinética , Animais , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacocinética , Benzamidas , Ensaios Clínicos como Assunto , Resistencia a Medicamentos Antineoplásicos , Humanos , Masculino , Nitrilas , Orquiectomia , Feniltioidantoína/efeitos adversos , Feniltioidantoína/farmacocinética , Feniltioidantoína/uso terapêutico , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/cirurgiaRESUMO
Prostate cancer is the most common solid-organ cancer affecting the male population. Men with metastatic prostate cancer treated with androgen ablation therapy often respond rapidly, with improvement in bone pain and decreases in serum prostate-specific antigen. However, almost all patients progress to the castrate-resistant state and until recently chemotherapy was the only treatment available with proven survival benefit. Abiraterone is a new class of anti-androgen with proven survival benefit post-chemotherapy. In this review we discuss the characteristics of abiraterone and the clinical trials that led to its approval for the treatment of patients with prostate cancer.
Assuntos
Androstenóis/farmacologia , Antineoplásicos/uso terapêutico , Orquiectomia , Neoplasias da Próstata/tratamento farmacológico , Androstenos , Androstenóis/uso terapêutico , Ensaios Clínicos como Assunto , Humanos , Masculino , Metástase Neoplásica , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgiaRESUMO
BACKGROUND: Multimodal recovery programmes decrease hospital stay. The objective of this systematic review was to assess how single-modality evidence-based care principles, regarding postoperative analgesia and postoperative nausea and vomiting (PONV) prophylaxis, combine to achieve this. METHODS: A systematic review of randomised controlled trials was performed. Relevant trials compared postoperative epidural analgesia/parenteral opioid analgesia/paracetamol/non-steroidal anti-inflammatory drugs (NSAIDs) and postoperative antiemetics. The effect on recovery was evaluated in terms of length of hospital stay, pain intensity, duration of gastrointestinal dysfunction and incidence of PONV. RESULTS: Twenty-three trials were included. Epidural anaesthesia failed to reduce length of stay or the incidence of PONV when compared to controls. Pain intensity and time to first bowel movement were reduced (p<0.05). Paracetamol did not reduce the incidence of PONV. NSAIDs reduced postoperative opioid consumption and the incidence of PONV (p<0.05). Dexamethasone and 5-HT3 antagonists reduced the incidence of PONV compared to controls. CONCLUSIONS: Epidural anaesthesia appears to not reduce length of hospital stay or incidence of PONV despite reducing pain intensity and ileus. NSAIDs are more effective than paracetamol in reducing postoperative opioid consumption and PONV, while dexamethasone and 5-HT3 antagonists are both effective in reducing PONV.
