Second-Line Hormonal Therapy for Men With Chemotherapy-Naïve, Castration-Resistant Prostate Cancer: American Society of Clinical Oncology Provisional Clinical Opinion

Abstract

Purpose ASCO provisional clinical opinions (PCOs) offer direction to the ASCO membership after publication or presentation of potential practice-changing data. This PCO addresses second-line hormonal therapy for chemotherapy-naïve men with castration-resistant prostate cancer (CRPC) who range from being asymptomatic with only biochemical evidence of CRPC to having documented metastases but minimal symptoms. Clinical Context The treatment goal for CRPC is palliation. Despite resistance to initial androgen deprivation therapy, most men respond to second-line hormonal therapies. However, guidelines have neither addressed second-line hormonal therapy for nonmetastatic CRPC nor provided specific guidance with regard to the chemotherapy-naïve population. Recent Data Six phase III randomized controlled trials and expert consensus opinion inform this PCO. Provisional Clinical Opinion For men with CRPC, a castrate state should be maintained indefinitely. Second-line hormonal therapy (eg, antiandrogens, CYP17 inhibitors) may be considered in patients with nonmetastatic CRPC at high risk for metastatic disease (rapid prostate-specific antigen doubling time or velocity) but otherwise is not suggested. In patients with radiographic evidence of metastases and minimal symptoms, enzalutamide or abiraterone plus prednisone should be offered after discussion with patients about potential harms, benefits, costs, and patient preferences. Radium-223 and sipuleucel-T also are options. No evidence provides guidance about the optimal order of hormonal therapies for CRPC beyond second-line treatment. Prostate-specific antigen testing every 4 to 6 months is reasonable for men without metastases. Routine radiographic restaging generally is not suggested but can be considered for patients at risk for metastases or who exhibit symptoms or other evidence of progression. Additional information is available at www.asco.org/genitourinary-cancer-guidelines and www.asco.org/guidelineswiki .

The establishment of immune infiltration based novel recurrence predicting nomogram in prostate cancer

“…However, for advanced PCa, hormonal deprivation therapy can temporarily inhibit tumor progression through the androgen receptor signaling pathway, but this function is only effective for approximately 2 years. Then, serum levels of prostate‐specific antibody (PSA) increase again rapidly, meeting the stage of castration‐resistant prostate cancer (CRPC), which is the leading cause of tumor‐specific death in PCa …”

“…Then, serum levels of prostate-specific antibody (PSA) increase again rapidly, meeting the stage of castration-resistant prostate cancer (CRPC), which is the leading cause of tumor-specific death in PCa. [11][12][13][14] Tumor-infiltrating immune cells (TIICs) are essential components of the tumor microenvironment and can alter the immune status of the tumor. Several studies have demonstrated therapeutic strategies against tumors by targeting TIICs.…”

Modification of American Joint Committee on cancer prognostic groups for renal cell carcinoma

“…Besides, overestimating the risks of T3N0M0 (9.6% of RCC patients) implied a higher disease burden with overtreatment of adjuvant therapy. [22][23][24] Evaluation of the efficacy and excessive treatment could be solved better if the future adjuvant therapy RCTs adopted the modified AJCC staging system and performed subgroup analysis accordingly. Collectively, our modified AJCC staging system may have some impact on the adjuvant therapy trials setting which is highly controversial according to recent trials.…”

The Role of YKL-40 in Predicting Resistance to Docetaxel Chemotherapy in Prostate Cancer

“…Treatment toxicity and baseline or acquired chemotherapy resistance represent the main risks for DOC-treated patients [3,7]. In the past few years, a large number of systemic therapies such as abiraterone acetate, enzalutamide and alpharadine has been approved for CRPC patients [6]. Two randomised prospective clinical studies demonstrated that the combination of DOC with Androgen deprivation therapy provides a substantial survival benefit also for hormone sensitive patients [8,9].…”

“…Androgen deprivation therapy is the "gold standard" treatment for advanced PCa [4]. While an initial response to therapy is common, most of patients will later develop biochemical, radiographic, and/or symptomatic evidence of cancer progression despite castrate levels of testosterone [5,6]. Docetaxel (DOC) represents a standard first-line treatment in men with castrationresistant prostate cancer (CRPC) for more than a decade.…”