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Editor’s Note: September 25-29, 2021.
The 24th National Clinical Oncology Conference and 2021 CSCO Annual Conference will be held on September 25-29 in a grand combination of online and offline
.
The theme of this conference is "Focus on Innovative Research, Leading the Future of Originality"
.
As one of the most influential academic celebrations in the field of oncology in China, big coffees from all over the country gather to talk about the research progress and innovation in the field of oncology
.
On the afternoon of September 27th, at the "Focus on the Forefront, Accuracy First" Prostate Cancer Precision Diagnosis and Treatment Forum, Professor Xie Xiaodong, Director of the Army Cancer Treatment Center of the Northern Theater General Hospital, reported on the interpretation of the 2021 CSCO prostate cancer diagnosis and treatment guidelines
.
As the average life expectancy in China has gradually increased, changes in eating habits and life>
.
In response to the urgent needs of the vast majority of prostate cancer patients in China, the CSCO Prostate Cancer Expert Committee promoted standardized treatment concepts to clinicians in urology and oncology departments across the country, and released the first edition of the CSCO Prostate Cancer Diagnosis and Treatment Guidelines last year
.
The guide group leader is Professor Ye Dingwei, the deputy team leaders are Professor Guo Jun, Professor He Zhisong, Professor Qi Jun, Professor Shi Benkang, Professor Wei Qiang, Professor Xie Xiaodong and Professor Zhou Fangjian, and the secretary is Professor Zhu Yao
.
Writing experts: Professor Zhu Yao, Professor Sheng Xinan, Professor Fan Yu, Professor Liu Hailong, Professor Chen Shouzhen, Professor Zeng Hao, Professor Guo Fang, Professor Li Yonghong, Professor He Liru and Professor Gu Weijie
.
After the official release of the guidelines, the response was overwhelmingly popular, and it quickly became the most important and authoritative reference material for the majority of urology medical staff in clinical work, which greatly helped and promoted the standardized process of prostate cancer diagnosis and treatment in China
.
In order to maintain the advanced nature and timeliness of the guidelines, the CSCO Prostate Cancer Committee and the guidelines writing team officially launched the update and revision of the 2021 guidelines in March this year
.
This update of the guidelines has four major characteristics: evidence-based medicine, keeping pace with the times; precision medicine, diagnosis first; drug availability, therapeutic value; local data, leading the guide
.
In this CSCO conference, Professor Xie Xiaodong summarized the updated points of metastatic hormone-sensitive prostate cancer (mHSPC), non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC)
.
Treatment of mHSPC mHSPC is defined as patients with advanced prostate cancer who have not received endocrine therapy at the time of metastasis.
According to the CHAARETD study, they are divided into high tumor burden and low tumor burden
.
The 2021 version of the CSCO guidelines for low tumor burden mHSCP treatment options are updated as follows: 1) Recommended "ADT-based combination therapy" for patients with first diagnosed metastatic prostate cancer, if there is no contraindication to the combination therapy, there is sufficient life expectancy from If you benefit from the combination therapy and are willing to accept the increased risk of side effects, you should not undergo androgen deprivation therapy (ADT) alone, and should be combined with other therapies on the basis of ADT
.
2) Update the research data of "ADT + abiraterone acetate + prednisone" LATITUDE and STAMPEDE studies suggest that ADT + abiraterone acetate combined with prednisone can prolong the overall survival time of mHSPC
.
The follow-up results of the STAMPEDE study (armG) showed that the 5-year overall survival rate of patients with ADT combined with abiraterone acetate treatment was increased from 41% to 60% compared with ADT alone
.
.
3) New "Cryotherapy" research data.
A domestic study showed that for newly diagnosed mHSPC patients, the median failure-free survival (FFS) of cryotherapy combined with ADT compared with ADT alone (39 months vs 21) Months, P=0.
005) and the median to castration resistance survival time is longer (39 months vs 21 months, P=0.
007).
Based on the results of this study, the new version of the guidelines includes ADT combined with cryotherapy into the third-level recommendation
.
Table 1 Treatment options for mHSPC with low tumor burden nmCRPC treatment nmCRPC is an independent disease stage in advanced prostate cancer, defined as: serum testosterone level <50ng/dl or 1.
7nmol/L; PSA progression: PSA>2ng/ml, interval In 1 week, 3 consecutive times were higher than the baseline by >50%; no distant metastasis was found in traditional imaging examination
.
For the treatment of nmCRPC, three new endocrine therapies, enzalutamide, apatamide, and dalotamide are recommended as the first choice.
The new guide updates the latest OS data of the PROSPER study of enzalutamide and the ARAMIS study data of dalotamide.
:1.
The PROSPER study shows that enzalutamide combined with ADT treatment compared with placebo group significantly prolonged metastasis-free survival (MFS) (36.
6 months vs 14.
7 months) and overall survival (OS) (67.
0 months vs 56.
3) Months), significantly reducing the risk of metastasis or death by 71%
.
In addition, the time to pain progression, time to first anti-tumor treatment, PSA development time, and quality of life assessment, etc.
, all show the therapeutic advantages of enzalutamide for patients with nmCRPC
.
2.
The ARAMIS study showed that dalotamide combined with ADT treatment compared with placebo group can significantly prolong the MFS (40.
4 months vs 18.
4 months), OS (83% vs 77%) and PFS (36.
8 months vs.
14.
8 months)
.
Table 2 The treatment options of nmCRPC The treatment of mCRPC mCRPC is defined as: serum testosterone level <50ng/dl or 1.
7nmol/L; serum PSA progression or imaging progression, which is sufficient
.
Based on the revision of the 2021 v2 NCCN guidelines, the new version of the CSCO guidelines redraws the tables in the mCRPC diagnosis and treatment chapters, and uses whether they have received new endocrine therapy/chemotherapy in the past to replace the traditional first-line and second-line classification methods to guide mCRPC patients at different stages Treatment
.
(See Table 3 for details)
.
Table 3 Comparison of mCRPC treatment options between the 2020 version of the guidelines and the 2021 version of the guidelines.
In addition to the update of the classification method for mCRPC patients, the selection of mCRPC treatment has also been updated on the basis of the first recommended new endocrine therapy.
The specific updates are as follows: 1) Adding "Olapali Domestic Real World Research Data" A domestic real world study showed that the overall PSA remission rate of olaparib for mCRPC was 48.
8%
.
Olapali has anti-tumor efficacy in both homologous recombination repair (HRR) mutations and non-mutated patients, and the adverse reactions are safe and controllable
.
2) Level III recommendation of "first-line endocrine failure without chemotherapy": add "abiraterone/dexamethasone" and add domestic retrospective research data After the progression of Nisone (AA+P), the treatment was changed to abiraterone+dexamethasone (AA+D).
The median PFS was 3.
7 months.
The treatment was well tolerated, and there were no grade 3 and 4 adverse reactions
.
3) Considering that "cabazitaxel" is not available in the country, the new version of the guide will reduce the treatment of cabazitaxel from level I recommendation to level II recommendation
.
4) Level II recommendation of "Previous endocrine therapy and docetaxel chemotherapy failure": add "Docetaxel" to challenge again; Level III recommendation: increase "clinical research" For highly selected patients, more use in the castration sensitive stage When the sitoxet reaction is good and no definite progress is made, it is recommended to use docetaxel to challenge again
.
New Clinical Study: The PARP inhibitors include Aura paclitaxel, paclitaxel-fluoro-oxazole, PSMA radionuclide therapy, Akt inhibitors and the like
.
Table 4 Diagnosis and treatment options for mCRPC, prevention and treatment of bone-related events The new version of the guidelines adds a new definition of bone-related events: bone-related events (skeletal related events, SREs): bone-related complications caused by bone metastases are called bone-related events
.
SREs mainly include pathological fractures (especially vertebral compression or deformation), spinal cord compression, symptoms after bone radiotherapy, progression of bone metastases, and hypercalcemia
.
Table 5 Prevention and treatment of bone-related events For patients with bone-related events after treatment of mCRPC patients, the new guidelines for the prevention and treatment of bone-related events are updated as follows: 1) When using bisphosphonates and desulumab, testing is required Blood calcium requires timely calcium and vitamin supplementation
.
2) Zoledronic acid can significantly reduce the occurrence of bone-related events.
The guidelines recommend that once bone metastases occur in patients, zoledronic acid can be used even if the patient is asymptomatic, but long-term use requires attention to mandibular osteonecrosis
.
3) The therapeutic use of analgesics is newly added
.
Summarizing the updated guidelines, it will be more suitable for the clinical treatment of prostate cancer, and more suitable for doctors to control the entire process of prostate cancer: 1) mHSPC and nm/mCRPC are important stages in the development of prostate cancer, and effective treatment interventions It is of great significance to improve the quality of life (QOL) and OS of patients; 2) The update of the mHSPC part focuses on low tumor burden, the transformation of treatment mode, the update of research data, and the innovation of treatment methods will provide strong evidence for clinical diagnosis and treatment Support; 3) The update of castration-resistant prostate cancer (CRPC) part can better serve the clinic, focusing on combining Chinese research data, and clarifying recommendations on issues such as bone-related events
.
The 24th National Clinical Oncology Conference and 2021 CSCO Annual Conference will be held on September 25-29 in a grand combination of online and offline
.
The theme of this conference is "Focus on Innovative Research, Leading the Future of Originality"
.
As one of the most influential academic celebrations in the field of oncology in China, big coffees from all over the country gather to talk about the research progress and innovation in the field of oncology
.
On the afternoon of September 27th, at the "Focus on the Forefront, Accuracy First" Prostate Cancer Precision Diagnosis and Treatment Forum, Professor Xie Xiaodong, Director of the Army Cancer Treatment Center of the Northern Theater General Hospital, reported on the interpretation of the 2021 CSCO prostate cancer diagnosis and treatment guidelines
.
As the average life expectancy in China has gradually increased, changes in eating habits and life>
.
In response to the urgent needs of the vast majority of prostate cancer patients in China, the CSCO Prostate Cancer Expert Committee promoted standardized treatment concepts to clinicians in urology and oncology departments across the country, and released the first edition of the CSCO Prostate Cancer Diagnosis and Treatment Guidelines last year
.
The guide group leader is Professor Ye Dingwei, the deputy team leaders are Professor Guo Jun, Professor He Zhisong, Professor Qi Jun, Professor Shi Benkang, Professor Wei Qiang, Professor Xie Xiaodong and Professor Zhou Fangjian, and the secretary is Professor Zhu Yao
.
Writing experts: Professor Zhu Yao, Professor Sheng Xinan, Professor Fan Yu, Professor Liu Hailong, Professor Chen Shouzhen, Professor Zeng Hao, Professor Guo Fang, Professor Li Yonghong, Professor He Liru and Professor Gu Weijie
.
After the official release of the guidelines, the response was overwhelmingly popular, and it quickly became the most important and authoritative reference material for the majority of urology medical staff in clinical work, which greatly helped and promoted the standardized process of prostate cancer diagnosis and treatment in China
.
In order to maintain the advanced nature and timeliness of the guidelines, the CSCO Prostate Cancer Committee and the guidelines writing team officially launched the update and revision of the 2021 guidelines in March this year
.
This update of the guidelines has four major characteristics: evidence-based medicine, keeping pace with the times; precision medicine, diagnosis first; drug availability, therapeutic value; local data, leading the guide
.
In this CSCO conference, Professor Xie Xiaodong summarized the updated points of metastatic hormone-sensitive prostate cancer (mHSPC), non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC)
.
Treatment of mHSPC mHSPC is defined as patients with advanced prostate cancer who have not received endocrine therapy at the time of metastasis.
According to the CHAARETD study, they are divided into high tumor burden and low tumor burden
.
The 2021 version of the CSCO guidelines for low tumor burden mHSCP treatment options are updated as follows: 1) Recommended "ADT-based combination therapy" for patients with first diagnosed metastatic prostate cancer, if there is no contraindication to the combination therapy, there is sufficient life expectancy from If you benefit from the combination therapy and are willing to accept the increased risk of side effects, you should not undergo androgen deprivation therapy (ADT) alone, and should be combined with other therapies on the basis of ADT
.
2) Update the research data of "ADT + abiraterone acetate + prednisone" LATITUDE and STAMPEDE studies suggest that ADT + abiraterone acetate combined with prednisone can prolong the overall survival time of mHSPC
.
The follow-up results of the STAMPEDE study (armG) showed that the 5-year overall survival rate of patients with ADT combined with abiraterone acetate treatment was increased from 41% to 60% compared with ADT alone
.
.
3) New "Cryotherapy" research data.
A domestic study showed that for newly diagnosed mHSPC patients, the median failure-free survival (FFS) of cryotherapy combined with ADT compared with ADT alone (39 months vs 21) Months, P=0.
005) and the median to castration resistance survival time is longer (39 months vs 21 months, P=0.
007).
Based on the results of this study, the new version of the guidelines includes ADT combined with cryotherapy into the third-level recommendation
.
Table 1 Treatment options for mHSPC with low tumor burden nmCRPC treatment nmCRPC is an independent disease stage in advanced prostate cancer, defined as: serum testosterone level <50ng/dl or 1.
7nmol/L; PSA progression: PSA>2ng/ml, interval In 1 week, 3 consecutive times were higher than the baseline by >50%; no distant metastasis was found in traditional imaging examination
.
For the treatment of nmCRPC, three new endocrine therapies, enzalutamide, apatamide, and dalotamide are recommended as the first choice.
The new guide updates the latest OS data of the PROSPER study of enzalutamide and the ARAMIS study data of dalotamide.
:1.
The PROSPER study shows that enzalutamide combined with ADT treatment compared with placebo group significantly prolonged metastasis-free survival (MFS) (36.
6 months vs 14.
7 months) and overall survival (OS) (67.
0 months vs 56.
3) Months), significantly reducing the risk of metastasis or death by 71%
.
In addition, the time to pain progression, time to first anti-tumor treatment, PSA development time, and quality of life assessment, etc.
, all show the therapeutic advantages of enzalutamide for patients with nmCRPC
.
2.
The ARAMIS study showed that dalotamide combined with ADT treatment compared with placebo group can significantly prolong the MFS (40.
4 months vs 18.
4 months), OS (83% vs 77%) and PFS (36.
8 months vs.
14.
8 months)
.
Table 2 The treatment options of nmCRPC The treatment of mCRPC mCRPC is defined as: serum testosterone level <50ng/dl or 1.
7nmol/L; serum PSA progression or imaging progression, which is sufficient
.
Based on the revision of the 2021 v2 NCCN guidelines, the new version of the CSCO guidelines redraws the tables in the mCRPC diagnosis and treatment chapters, and uses whether they have received new endocrine therapy/chemotherapy in the past to replace the traditional first-line and second-line classification methods to guide mCRPC patients at different stages Treatment
.
(See Table 3 for details)
.
Table 3 Comparison of mCRPC treatment options between the 2020 version of the guidelines and the 2021 version of the guidelines.
In addition to the update of the classification method for mCRPC patients, the selection of mCRPC treatment has also been updated on the basis of the first recommended new endocrine therapy.
The specific updates are as follows: 1) Adding "Olapali Domestic Real World Research Data" A domestic real world study showed that the overall PSA remission rate of olaparib for mCRPC was 48.
8%
.
Olapali has anti-tumor efficacy in both homologous recombination repair (HRR) mutations and non-mutated patients, and the adverse reactions are safe and controllable
.
2) Level III recommendation of "first-line endocrine failure without chemotherapy": add "abiraterone/dexamethasone" and add domestic retrospective research data After the progression of Nisone (AA+P), the treatment was changed to abiraterone+dexamethasone (AA+D).
The median PFS was 3.
7 months.
The treatment was well tolerated, and there were no grade 3 and 4 adverse reactions
.
3) Considering that "cabazitaxel" is not available in the country, the new version of the guide will reduce the treatment of cabazitaxel from level I recommendation to level II recommendation
.
4) Level II recommendation of "Previous endocrine therapy and docetaxel chemotherapy failure": add "Docetaxel" to challenge again; Level III recommendation: increase "clinical research" For highly selected patients, more use in the castration sensitive stage When the sitoxet reaction is good and no definite progress is made, it is recommended to use docetaxel to challenge again
.
New Clinical Study: The PARP inhibitors include Aura paclitaxel, paclitaxel-fluoro-oxazole, PSMA radionuclide therapy, Akt inhibitors and the like
.
Table 4 Diagnosis and treatment options for mCRPC, prevention and treatment of bone-related events The new version of the guidelines adds a new definition of bone-related events: bone-related events (skeletal related events, SREs): bone-related complications caused by bone metastases are called bone-related events
.
SREs mainly include pathological fractures (especially vertebral compression or deformation), spinal cord compression, symptoms after bone radiotherapy, progression of bone metastases, and hypercalcemia
.
Table 5 Prevention and treatment of bone-related events For patients with bone-related events after treatment of mCRPC patients, the new guidelines for the prevention and treatment of bone-related events are updated as follows: 1) When using bisphosphonates and desulumab, testing is required Blood calcium requires timely calcium and vitamin supplementation
.
2) Zoledronic acid can significantly reduce the occurrence of bone-related events.
The guidelines recommend that once bone metastases occur in patients, zoledronic acid can be used even if the patient is asymptomatic, but long-term use requires attention to mandibular osteonecrosis
.
3) The therapeutic use of analgesics is newly added
.
Summarizing the updated guidelines, it will be more suitable for the clinical treatment of prostate cancer, and more suitable for doctors to control the entire process of prostate cancer: 1) mHSPC and nm/mCRPC are important stages in the development of prostate cancer, and effective treatment interventions It is of great significance to improve the quality of life (QOL) and OS of patients; 2) The update of the mHSPC part focuses on low tumor burden, the transformation of treatment mode, the update of research data, and the innovation of treatment methods will provide strong evidence for clinical diagnosis and treatment Support; 3) The update of castration-resistant prostate cancer (CRPC) part can better serve the clinic, focusing on combining Chinese research data, and clarifying recommendations on issues such as bone-related events
.
