编者按：高达80%接受雄激素剥夺治疗（ADT）治疗的患者会出现潮热和盗汗（HFNS）症状，这不仅降低了生活质量，还可能影响ADT治疗患者的依从性，目前缓解方法有限。2024年美国临床肿瘤学会年会（ASCO 2024）上，英国南安普顿大学医院Simon J.Crabb教授汇报了MANCAN2研究结果，《肿瘤瞭望》有幸邀请Simon J.Crabb教授分享他对前列腺癌管理的思考。

 

Simon J.Crabb教授：在某个治疗阶段，大约一半的前列腺癌患者会接受ADT。此外，许多患者还会在ADT的基础上使用雄激素受体（AR）靶向药物。尽管这些疗法有效，但也伴随着一系列潜在的副作用，例如疲劳、潮热、盗汗、代谢问题、骨骼健康问题和心血管事件。

 

在我们中心，我们首先会与患者进行全面讨论，解释潜在的副作用。我们发现前列腺癌护士专家团队与患者合作制定应对这些副作用的策略非常成功。我们重点关注骨骼健康。每位患者在治疗开始时都会进行DEXA扫描以评估骨骼健康情况。我们提供钙和维生素D补充剂，并根据DEXA扫描结果来决定是否需要使用双膦酸盐。心血管健康也需要重点关注。我们确保高血压等心血管疾病得到良好控制，并管理其他心脏风险因素，这有助于减轻ADT相关的心血管风险。

 

Oncology Frontier:Androgen deprivation therapy(ADT)is the standard treatment for localized，recurrent，and metastatic prostate cancer，but it can also cause adverse reactions for patients.Based on your clinical experience，please share how to manage these adverse reactions?

 

Dr.Simon J.Crabb:Certainly.About half of prostate cancer patients will receive androgen deprivation therapy at some point during their treatment.Additionally，many patients will also receive an AR-targeted agent alongside ADT.While these therapies are effective，they come with a range of potential side effects，including fatigue，hot flushes，night sweats，metabolic issues，bone health problems，and cardiovascular events.

 

We start with a comprehensive discussion with the patient about the potential side effects.We have found great success in utilizing prostate cancer nurse specialists who work with patients to develop coping strategies for these side effects.A key area we focus on is bone health.Every patient undergoes a DEXA scan at the start of treatment to assess bone health.We provide calcium and vitamin D supplementation and determine the need for bisphosphonates based on the DEXA scan results.

 

Addressing cardiovascular health is crucial.We ensure that conditions like hypertension are well controlled and manage other cardiac risk factors.This comprehensive approach helps mitigate the cardiovascular risks associated with ADT.

 

Simon J.Crabb教授：大约80%接受ADT的患者会受到潮热和盗汗的影响，这些症状会显著影响他们的生活质量，还可能导致抑郁、焦虑和认知问题，有时会影响患者继续治疗的意愿。尽管药物治疗可以管理这些症状，但并非总是理想的。因此我们一直在探索非药物治疗方法，例如认知行为疗法（CBT），这在减少潮热和盗汗的频率和影响方面展现出积极的潜力。

 

Oncology Frontier:Current treatment emphasizes patient-centeredness，and you have also conducted the relevant MANCAN2 study.So what role can CBT play in the management of ADT-related hot flashes and night sweats?

 

Dr.Simon J.Crabb:Hot flushes and night sweats affect about 80%of patients on ADT and can significantly impact their quality of life.These symptoms can also lead to depression，anxiety，and cognitive issues，and sometimes affect the patients’willingness to continue their therapy.While pharmacological approaches exist to manage these symptoms，they are not always ideal.We have been exploring non-pharmacological approaches，such as cognitive behavioural therapy(CBT)，which has shown promise in reducing the frequency and impact of hot flushes and night sweats.

 

Simon J.Crabb教授：在ASCO会议上我们展示了MANCAN2研究结果。这是一项随机对照试验，将接受ADT患有潮热的前列腺癌患者分配到接受标准护理或CBT（为期4周的自我管理干预，包括小册子和放松音频）组。我们发现，CBT在早期（最多六周）显著减轻了潮热的影响。然而，这一效果在六个月时并未维持。这表明需要更长时间的干预，可能需要加强课程以维持CBT的益处。有趣的是，CBT还与ADT的更好依从性相关，这是未来研究的重要方向，值得进一步探索。

 

Oncology Frontier:What research will you conduct in the future to further improve the quality of life of prostate cancer patients?

 

Dr.Simon J.Crabb:At ASCO 2024，we presented data from the MANCAN2 study，a randomized trial where prostate cancer patients on ADT with hot flushes were assigned to receive either standard care or CBT.We found that CBT significantly reduced the impact of hot flushes at early time points，up to six weeks.However，these effects were not sustained at six months.This suggests a need for longer intervention durations and possibly booster sessions to maintain the benefits of CBT.Interestingly，CBT was also associated with better compliance with ADT，which is an important area for future development.