Molecular underpinnings of systemic treatment resistance in metastatic castration-resistant prostate cancer

Abstract:

:In the last few years, several new drugs with various mechanisms of action have been approved for the treatment of castration-resistant prostate cancer. Due to this development, therapeutic decision-making has become increasingly complex. Therefore, therapy selection as well as timing and sequence of treatments need to be optimized in an individual manner. In addition, also for these novel therapies, baseline and acquired as well as cross-resistance have been observed. Underlying mechanisms become increasingly clear, resulting in a shift from empiric-based towards rational-based therapeutic decision-making. In the present review, we provide an overview on the resistance mechanisms against the most frequently applied systemic treatments of metastatic castration-resistant prostate cancer such as docetaxel, abiraterone and enzalutamide. We summarize - among others - the mechanisms by MDR (multidrug-resistant) protein expression, alterations of androgen receptor, Wnt, p53 and DNA-repair pathways (BRCA/ATM) as well as resistance through therapy-induced neuroendocrine differentiation of the tumour. Orv Hetil. 2020; 161(20): 813-820. :A metasztatikus kasztrációrezisztens prosztatarák kezelésére az elmúlt években számos új, különböző hatásmechanizmusú gyógyszeres kezelés vált elérhetővé. Ez a fejlődés a terápiás döntéshozatalt egyre nehezebbé teszi. Az újabb kezelésekkel szemben is megfigyelhető az alapvonali, a szerzett és a keresztrezisztencia jelensége is. Ezért tehát az elsődleges terápia helyes megválasztása mellett, az azt követő vonalakban alkalmazott kezelések sorrendje és alkalmazásuk ideje is optimalizálásra szorul. Az újabb kezelésekkel kapcsolatos rezisztenciamechanizmusok egyre nagyobb mértékben válnak ismertté. Ezzel a terápiatervezés az eddigi empirikus – főleg a kipróbálásra építő – irányából egyre inkább a racionális – az adott daganat molekuláris sajátságait is figyelembe vevő –, személyre szabott kezelés irányába mozdul el. Ebben az összefoglaló közleményben ismertetjük azokat a rezisztenciamechanizmusokat, amelyek a metasztatikus kasztrációrezisztens prosztatarák kezelésében leggyakrabban használt három gyógyszerrel – docetaxel, abirateron és enzalutamid – kapcsolatosak. Többek között áttekintést nyújtunk a MDR- (multidrogrezisztens) fehérjéken keresztül megvalósuló, az androgénreceptor-, a Wnt-, a p53-szignálút, valamint a DNS hibajavító mechanizmusában részt vevő gének (mint például a BRCA és ATM) sérüléseivel összefüggésben kialakuló és a neuroendokrin differenciáció által kiváltott rezisztenciamechanizmusokról. Orv Hetil. 2020; 161(20): 813–820.

journal_name

Orv Hetil

journal_title

Orvosi hetilap

authors

Szarvas T,Csizmarik A,Nagy N,Keresztes D,Váradi M,Küronya Z,Riesz P,Nyirády P

doi

10.1556/650.2020.31734

subject

Has Abstract

pub_date

2020-05-01 00:00:00

pages

813-820

issue

20

eissn

0030-6002

issn

1788-6120

journal_volume

161

pub_type

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