Sequential use of novel therapeutics in advanced prostate cancer following docetaxel chemotherapy
Omlin A1, Pezaro C2, Gillessen Sommer S3. Ther Adv Urol. 2014 Feb;6(1):3-14.

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1Kantonsspital St Gallen, Abteilung fuer Medizinische Onkologie, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland. 2Monash University Eastern Health Clinical School, Australia. 3Kantonsspital St Gallen, St Gallen, Switzerland.


In the last three years, five novel treatments have been shown to improve survival in metastatic castration-resistant prostate cancer (CRPC). These novel treatments have distinct mechanisms of action: tubulin-binding chemotherapy (cabazitaxel); immunotherapy (sipuleucel-T); CYP-17 inhibition (abiraterone); androgen receptor (AR) blockade (enzalutamide); and radioisotope therapy (radium-223). For a number of years, docetaxel was the only treatment with a proven survival benefit for patients with CRPC. Therefore, somewhat artificially, three treatment spaces for drug development in CRPC have emerged: pre-docetaxel; docetaxel combinations; and post-docetaxel. For patients progressing after docetaxel-based chemotherapy, treatment options available outside of clinical trials now include abiraterone, cabazitaxel and enzalutamide. Prospective data on how to best use these novel agents sequentially are not available. Clinicians face the difficult task of choosing between treatment options for individual patients to maximize patient benefit. Treatment evaluation in patients with CRPC remains challenging due to the predominance of bone metastatic disease and the lack of validated surrogate markers for survival. This review summarizes the data available with regards to sequencing of the novel treatments for CRPC.