Patrones de tratamiento sistémico en el cáncer de próstata metastásico hormonosensible en distintos períodos en un hospital de alta complejidad

Mariano D. Aymar; Matías Cerini; Federico Cayol

doi:10.56969/oc.v28i1.134

Autores/as

Mariano D. Aymar Servicio de Oncología, Hospital Italiano de Buenos Aires
Matías Cerini Sección de Oncología, Hospital Italiano de Buenos Aires
Federico Cayol Sección de Oncología Clínica, Hospital Italiano de Buenos Aires https://orcid.org/0000-0001-9794-2173

DOI:

https://doi.org/10.56969/oc.v28i1.134

Palabras clave:

cáncer de próstata sensible a la castración, docetaxel, nuevas hormonoterapias, países en desarrollo, hormone sensitive prostate cancer, new hormone therapy, developing countries

Resumen

Introducción: El tratamiento del cáncer de próstata metastásico hormonosensible (CPSCm) ha cambiado debido a la incorporación de tratamientos combinados que prolongan la supervivencia (TCPS). No conocemos datos de cómo han sido incorporadas estas nuevas opciones en la Argentina.Objetivos: Describir patrones de tratamiento de CPSCm en diferentes periodos y comparar la supervivencia global (SG) entre las diferentes modalidades. Métodos: Serie retrospectiva de pacientes con diagnóstico de CPSCm tratados en la sección de oncología del Hospital Italiano de Buenos Aires entre 2010 y 2021. Seguimiento mediano de 25 meses. Resultados: Se evaluaron 1110 pacientes con cáncer de próstata, de los cuales 405 tuvieron metástasis en su evolución, 194 eran hormonosensibles. Edad mediana 71 años (RIQ 63 - 77). 81.7% Gleason Grupo 4- 5. 76% metastásicos de novo. PSA mediano previo al tratamiento 67.6 ng/ml (RIQ 20- 300). El 60% cumplían criterios CHAARTED para alto volumen.

En cuanto al tratamiento, el 21% recibió deprivación androgénica (ADT) monoterapia, 53% ADT combinado con antiandrógenos de primera generación (BAC), 26 % TCPS. Considerando 3 periodos: antes de 2015, del 2015-2018, >2018, se observó la utilización de análogos monoterapia o con BAC vs. TCPS en 97% vs. 3%, 76% vs. 24%, 47% vs. 53% (Chi2 p=0.0001). La supervivencia global mediana en años fue de 3.05 años para ADT,

3.30 años para BAC y 3.63 años TCPS, diferencia no estadísticamente significativa (Log Rank test p=0.94). Discusión: Aunque la incorporación de TCPS ha aumentado en los distintos períodos, aún un 47% continúa recibiendo un tratamiento insuficiente según estándares actuales. Es importante lograr mayor accesibilidad.

Citas

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