Metastatic Castrate-Resistant Prostate Cancer: New Landscape, New Challenges

Bahl, Amit; Persad, Raj

doi:10.1016/j.bjmsu.2011.05.003

Cited by 3 publications

(3 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,16 Advocates of the "cabazitaxel-first" strategy argue that it ensures delivery of cabazitaxel before a decline in performance status renders the patient ineligible for cytotoxic therapy; this strategy retains the option of subsequent abiraterone and thereby maximizes the likelihood of eligible patients receiving both of these licensed treatments (Fig. 5).…”

Section: -15mentioning

confidence: 99%

Post-docetaxel options for further survival benefit in metastatic castration-resistant prostate cancer: Questions of choice

Asselah¹,

Sperlich²

2013

CUAJ

View full text Add to dashboard Cite

There are currently two medical treatments approved in Canada that offer survival benefits for patients with metastatic castrationresistant prostate cancer that progresses on or after docetaxel-based chemotherapy, and evidence is accumulating on the efficacy of further interventions in this setting. The current and emerging strategies are based on a variety of mechanisms (cytotoxicity, hormonal inhibition, radiopharmacy and immunotherapy) and there is nothing to suggest that patients will be unable to benefit from several or even all of these agents when used sequentially. Given the possibility of multiple lines of treatment for patients whose disease progresses on or after docetaxel, the challenge for clinicians will be to determine the optimum treatment pathway for each individual. That challenge is already being faced, albeit on a limited scale, now that both cabazitaxel (chemotherapy) and abiraterone (hormonal agent) are available for use post-docetaxel. IntroductionAs recently as the beginning of the 21st century, metastatic castration-resistant prostate cancer (mCRPC) had a bleak prognosis. The available treatments, such as radiotherapy, boneseeking isotopes, bisphosphonates, chemotherapy, corticosteroids and analgesics, offered palliation of symptoms, but no improvement in survival. 1 In the past 8 years, the outlook has changed dramatically. First, the landmark TAX327 trial of docetaxel demonstrated that, contrary to previous experience, 2 mCRPC was responsive to chemotherapy in terms of patient survival.1 Then, in 2010, after 6 years with no treatment offering a survival benefit in the post-docetaxel setting, phase III data on cabazitaxel showed that patients could derive further survival benefit from second-line chemotherapy.3 In 2011, the hormonal agent abiraterone was also reported to improve survival in patients previously treated with docetaxel. 4 Both cabazitaxel and abiraterone are now approved for use in Canada for the treatment of mCRPC that has progressed during or after docetaxel-based chemotherapy. In addition, evidence is accumulating from trials of other agents, not yet approved in Canada, that offer a survival benefit in mCRPC.With these ongoing therapeutic developments, the multidisciplinary team caring for men with mCRPC has a growing choice of agents to use in the post-docetaxel setting. The recent and emerging treatments vary widely in their mode of action (cytotoxicity, hormonal inhibition, radiopharmacy, immunotherapy), and there is no suggestion, to date, that patients will be able to benefit from only one of the postdocetaxel options. Indeed, the possibility has been mooted of mCRPC entering an age of chronic-disease-style management, with an array of treatments, each improving the survival of the individual.5 Even with the choice narrowed to the two agents currently approved for use post-docetaxel, it is anticipated that patients will be able to derive a survival advantage from both cabazitaxel and abiraterone. 6 The key question for clinicians and their patients is: how ...

show abstract

Section: -15mentioning

confidence: 99%

Post-docetaxel options for further survival benefit in metastatic castration-resistant prostate cancer: Questions of choice

Asselah¹,

Sperlich²

2013

CUAJ

View full text Add to dashboard Cite

show abstract

“…However, as discussed elsewhere in this supplement [6], several new treatments for mCRPC are emerging and can be expected to reach the clinical arena soon. The first of these to receive a European licence is cabazitaxel, a novel chemotherapy agent that has delivered level 1 evidence of a survival benefit in mCRPC post-docetaxel in a phase III clinical trial [7].…”

Section: S15mentioning

confidence: 99%

“…Around the time that the TROPIC trial data were reported in 2010, interim data were presented from the COU-AA-301 trial of abiraterone acetate--a novel hormonal agent--demonstrating survival benefit over placebo in patients with mCRPC previously treated with docetaxel [14]. Other potential agents for this indication are in the pipeline (which are considered in detail elsewhere in this supplement: [6]). So, after several years with no active secondline treatment post-docetaxel, we have embarked on a new decade with potentially a choice of at least two such agents--and some inevitable questions for clinicians.…”

Section: Implications For Practice: a Tropic Trialist's Perspectivementioning

confidence: 99%

Cabazitaxel: Evidence and Clinical Experience

Malik

2011

British Journal of Medical and Surgical Urology

View full text Add to dashboard Cite

Cabazitaxel, a novel taxane that lacks susceptibility to the drugresistance mechanism seen with previous drugs in the same class, has demonstrated a survival benefit in metastatic castrate-resistant prostate cancer (mCRPC), plus a manageable toxicity profile. It is the first active treatment to receive a European licence for the second-line treatment of mCRPC post-docetaxel. Novel non-chemotherapeutic treatments for this indication are at various stages of development and regulatory status. These new and emerging treatments bring a potential opportunity to extend the lives of patients with mCRPC, and improve quality of life in this setting, but they also raise pertinent questions about the optimal timing and sequencing of their use. Based on my clinical experience with cabazitaxel, first as a phase III trialist, and then as a participant in an expanded-access programme, I believe that the chemotherapeutic option should be offered before non-chemotherapeutic agents, where the patient's performance status allows, so that there is an opportunity to gain the potential benefits of this treatment within the likely therapeutic window. Other second-line/third-line treatments, notably the hormonal agent abiraterone, are likely to remain useful even after a decline in the patient's performance status.

show abstract