Clinical implications for a treatment algorithm and differential indication to hormone therapy and chemotherapy options in metastatic castrate-resistant prostate cancer: a personal view.

Abstract

Although docetaxel is still considered a mainstay of treatment in metastatic castrate-resistant prostate cancer (mCRPC), in the last few years, new agents have been developed to improve survival in this setting and reach a possible optimal personalized treatment strategy. In this paper, we provide a personal view and an algorithm for mCRPC patients, according to available evidence, personal opinion and experience. Abiratone acetate, cabazitaxel, radium-223, sipuleucel-T and enzalutamide, together with docetaxel, have demonstrated a survival benefit in these patients. The use of rechallenge with docetaxel in mCRPC patients with disease progression after a first response has been considered. These new agents complicated the scenario and posed the challenge to move from the old sequential to a new algorithm-based approach. At this stage, the algorithm is necessarily based on experts' opinion, since the efficacy of a single agent in a specific setting has not been validated by sequential trials.

• Authors: Sergio Bracarda, Michele Sisani, Francesca Marrocolo, Alketa Hamzaj, Sabrina Del Buono, Amelia Altavilla
• Journal: Expert review of anticancer therapy (Expert Rev Anticancer Ther) Vol. 14 Issue 11 Pg. 1283-94 (Nov 2014) ISSN: 1744-8328 [Electronic] England
• PMID: 25353258 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Androgen Antagonists
• Antineoplastic Agents
• Taxoids
• Tissue Extracts
• Docetaxel
• sipuleucel-T

Topics

• Algorithms
• Androgen Antagonists (therapeutic use)
• Antineoplastic Agents (therapeutic use)
• Docetaxel
• Drug Resistance, Neoplasm
• Humans
• Male
• Prostatic Neoplasms, Castration-Resistant (diagnosis, drug therapy)
• Randomized Controlled Trials as Topic (methods)
• Taxoids (therapeutic use)
• Tissue Extracts (therapeutic use)