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L’Agenzia Italiana del Farmaco ( AIFA ) ha approvato Nubeqa ( Darolutamide ), un inibitore del recettore degli androgeni, più terapia di deprivazione androgenica in associazione alla chemioterapia con Docetaxel, nel trattamento del carcinoma prostatico ormonosensibile metastatico 

Sono stati stimati 41.100 nuovi casi di tumore alla prostata in Italia nel 2023, con un incremento di 5.100 diagnosi in tre anni.

Sintomi come la frequente necessità di urinare, il dolore alla minzione e la presenza di sangue nelle urine vengono spesso sottovalutati dai pazienti, portando alla scoperta della malattia in fase avanzata. L’impatto del tumore della prostata metastatico sulla quotidianità dei pazienti che sviluppano sintomi correlati alla malattia può essere importante: in alcuni casi, queste persone non riescono a dormire o a camminare per il dolore, in particolare alle ossa.

Nello studio di fase III ARASENS, che ha coinvolto più di 1300 pazienti, Darolutamide in associazione alla terapia ormonale e alla chemioterapia ha ridotto in modo significavo il rischio di mortalità del 32,5% rispetto alla terapia di deprivazione androgenica e Docetaxel, nei pazienti con tumore alla prostata metastatico ormonosensibile.

Nubeqa era già stato approvato a febbraio 2021 dall’AIFA per il trattamento dei pazienti con tumore della prostata non-metastatico resistente alla castrazione, a rischio elevato di sviluppare metastasi.

Lo studio ARASENS è stato pubblicato su The New England Journal of Medicine nel 2022.

Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer

Darolutamide is a potent androgen-receptor inhibitor that has been associated with increased overall survival among patients with nonmetastatic, castration-resistant prostate cancer. Whether a combination of Darolutamide, androgen-deprivation therapy, and Docetaxel would increase survival among patients with metastatic, hormone-sensitive prostate cancer is unknown.

In this international, phase 3 trial, researchers have randomly assigned patients with metastatic, hormone-sensitive prostate cancer in a 1:1 ratio to receive Darolutamide ( at a dose of 600 mg [ two 300-mg tablets ] twice daily ) or matching placebo, both in combination with androgen-deprivation therapy and Docetaxel. The primary end point was overall survival.

The primary analysis involved 1306 patients ( 651 in the Darolutamide group and 655 in the placebo group ); 86.1% of the patients had disease that was metastatic at the time of the initial diagnosis. At the data cutoff date for the primary analysis ( October 25, 2021 ), the risk of death was significantly lower, by 32.5%, in the Darolutamide group than in the placebo group ( hazard ratio, HR= 0.68; 95% confidence interval, 0.57 to 0.80; P less than 0.001 ). Darolutamide was also associated with consistent benefits with respect to the secondary end points and prespecified subgroups. Adverse events were similar in the two groups, and the incidences of the most common adverse events ( occurring in greater than or equal to 10% of the patients ) were highest during the overlapping Docetaxel treatment period in both groups. The frequency of grade 3 or 4 adverse events was 66.1% in the Darolutamide group and 63.5% in the placebo group; neutropenia was the most common grade 3 or 4 adverse event ( in 33.7% and 34.2%, respectively ).

In this trial involving patients with metastatic, hormone-sensitive prostate cancer, overall survival was significantly longer with the combination of Darolutamide, androgen-deprivation therapy, and Docetaxel than with placebo plus androgen-deprivation therapy and Docetaxel, and the addition of Darolutamide led to improvement in key secondary end points. The frequency of adverse events was similar in the two groups.

Source: The NEw England Journal of Medicine, 2022 [ https://www.nejm.org/doi/full/10.1056/NEJMoa2119115

Xagena Oncologia

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