I read with interest the Mini Review paper by Masson and Bahl  on metastatic castrate-resistant prostate cancer (mCRPC).
I fully agree with the authors' message that we are witnessing the ‘dawn of a new age management’; however, some new data concerning novel hormonal agents have been published since this paper was submitted, and I feel that an update is necessary.
With regard to patients with mCRPC after docetaxel failure:
- Abiraterone: the final analysis of the COU-AA-301 , published in October, confirms the value of this drug in patients who have undergone chemotherapy.
- Enzalutamide (formerly called MDV3100): the phase 3 AFFIRM trial has just been published in the September issue of the NEJM , demonstrating higher survival rates with enzalutamide in this setting.
- So now, we have two established oral agents in the treatment of post-docetaxel mCRPC, and the selection between these agents or cabazitaxel needs to be addressed.
With regard to chemotherapy-naïve patients:
- Abiraterone: data from the long-awaited COU-AA-302 are now available. This study was terminated early and unblinded as a result of an Independent Data Monitoring Committee decision. The results, presented at ASCO 2012 by Ryan et al. , revealed statistically better progression-free survival (PFS) and overall survival (OS) rates.
- Enzalutamide: the PREVAIL study is a phase III randomized, double-blind, placebo-controlled trial in chemo-naïve patients with mCRPC. The endpoints are OS and PFS. The study was closed to accrual in March 2012 and the results are awaited.
- The COU-AA-302 positive results with abiraterone (and the awaited PREVAIL trial data), along with the excellent safety profile of these two drugs, may signal a new paradigm shift in this era, leading us to investigate the appropriate sequencing in chemotherapy-naïve patients.