| Título: | Optimal prophylactic and definitive therapy for bicalutamide-induced gynecomastia: results of a meta-analysis |
| Autores: |
Tunio, M. A.; Department of Radiation oncology, King Fahad Medical City (KFMC) Riyadh, Saudi Arabia Al-Asiri, M.; Consultant Radiation Oncology Prince Suleman Hematology and Oncology Center King Fahad Medical City (KFMC) Riyadh Al-Amro, A.; Consultant Radiation Oncology Prince Suleman Hematology and Oncology Center King Fahad Medical City (KFMC) Riyadh Bayoumi, Y.; Consultant Radiation Oncology Prince Suleman Hematology and Oncology Center King Fahad Medical City (KFMC) Riyadh Fareed, M.; Assistant Consultant Radiation Oncology Prince Suleman Hematology and Oncology Center King Fahad Medical City (KFMC) Riyadh |
| Fecha: | 2012-08-02 |
| Publicador: | Multimed Inc. |
| Fuente: |
Ver documento |
| Tipo: |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
| Tema: | Meta-analysis; bicalutamide-induced gynecomastia; prostate cancer |
| Descripción: | Objective Bicalutamide is approved as an adjuvant to primary treatments (radical prostatectomy or radiotherapy) or as monotherapy in men with locally advanced, nonmetastatic prostate cancer (PCa). However, this treatment induces gynecomastia in most patients, which often results in treatment discontinuation. Optimal therapy for these breast events is not known so far. We undertook a meta-analysis to assess the efficacy of various treatment options for bicalutamideinduced gynecomastia. Methods The MEDLINE, CANCERLIT, and Cochrane library databases were searched and the Google search engine was used to identify prospective and retrospective controlled studies published in English from January 2000 to December 2010 comparing prophylactic or curative treatment options with a control group (no treatment) for PCa patients who developed bicalutamide-induced gynecomastia. Radiotherapyinduced cardiotoxicity was also evaluated. Results The search identified nine controlled trials with a total patient population of 1573. Pooled results from prophylactic trials showed a significant reduction of gynecomastia in PCa patients treated with prophylactic tamoxifen 20 mg daily (odds ratio: 0.06; 95% confidence interval: 0.05 to 0.09; p = 0.09), and pooled results from treatment trials showed a significant response of gynecomastia to definitive radiotherapy (odds ratio: 0.06; 95% confidence interval: 0.01 to 0.24; p < 0.0001). Aromatase inhibitors and weekly tamoxifen were not found to be effective as prophylactic and curative options. For the radiotherapy, skin-to-heart distance was found to be an important risk factor for cardiotoxicity (p = 0.006). A funnel plot of the meta-analysis showed significant heterogeneity (Egger test p < 0.00001) because of low sample size. Conclusions Our meta-analysis suggests using prophylactic tamoxifen 20 mg daily as the first-line preventive measure and radiotherapy as the first-line treatment option for bicalutamide-induced gynecomastia. Aromatase inhibitors and weekly tamoxifen are not recommended. |
| Idioma: | Inglés |
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