Systemic Medical Treatment in Men with Metastatic Castration-Resistant Prostate Cancer: Recommendations for Daily Routine

Abstract

The approval or clinical evaluation of several new agents - cabazitaxel, abiraterone acetate, enzalutamide, sipuleucel-T, and radium-223 - has significantly changed the management of patients with metastatic castration-resistant prostate cancer (mCRPC) prior to or after docetaxel-based chemotherapy. All of these agents have resulted in a significant survival benefit as compared to their control group. However, treatment responses might differ depending on the associated comorbidities and the extent and biological aggressiveness of the disease. Furthermore, treatment-associated side effects differ between the various drugs. As new drugs become approved, new treatment strategies and markers to best select which patients will best respond to which drug are needed. It is the aim of the current article to i) summarize the data of established treatment options in mCRPC, ii) highlight new developments in medical treatment, iii) provide clinically useful algorithms for the daily routine, and iv) point out future developments in medical treatment.

ESMO 2018—personal highlights

“…In past years the landscape of treatment options in patients with mCRPC has been extended. Beside chemotherapeutic options (docetaxel, cabazitaxel) next generations ADT like abiraterone acetate + prednisone or enzalutamide have proven clinical efficacy and are successfully used in daily routine [9]. Radium-223 is a targeted alpha-emitter, approved since 2013 for mCRPC with bone metastases [10].…”

The Impact of Cand1 in Prostate Cancer

“…However, after a time of about 2-3 years, patients experience resistance to androgen deprivation therapy (metastatic castration-resistant prostate cancer, mCRPC). In the past five years, several new therapeutic options targeting the androgen receptor (AR)-signaling axis have been developed for this patient population, including the AR-inhibiting agent enzalutamide [5,6]. Response to these drugs, however, is only temporary, as the majority of treated patients develop drug resistance.…”

New Developments in the Management of Prostate Cancer

“…However, as summarized by Hocine Habchi and Nicolas Mottet [4], new options such as chemo-hormonal therapy as well as the potential risk of significant side effects, such as cardiovascular disease, diabetes mellitus, and metabolic syndrome, have to be considered in the optimal management of the individual patient. Treatment of castration resistant prostate cancer has been revolutionized during recent years and Jan Herden and colleagues will cover all the clinically important therapeutic modalities with their advantages and disadvantages [5]. Together with my colleagues, it will be my pleasure to summarize surgical strategies in the palliative management of prostate cancer patients [6].…”