D.J.L and E.K.C. contributed equally.
Novel therapeutics for the management of castration-resistant prostate cancer (CRPC)
Article first published online: 28 OCT 2011
© 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL
Volume 109, Issue 7, pages 968–985, April 2012
How to Cite
Lee, D. J., Cha, E. K., Dubin, J. M., Beltran, H., Chromecki, T. F., Fajkovic, H., Scherr, D. S., Tagawa, S. T. and Shariat, S. F. (2012), Novel therapeutics for the management of castration-resistant prostate cancer (CRPC). BJU International, 109: 968–985. doi: 10.1111/j.1464-410X.2011.10643.x
- Issue published online: 13 MAR 2012
- Article first published online: 28 OCT 2011
- Accepted for publication 27 July 2011
- castration-resistant prostate cancer;
- prostate-specific antigen;
- cytotoxic agents;
- first-line therapy;
- second-line therapy
What's known on the subject? and What does the study add?
Historically, therapies for CRPC have primarily been chemotherapy-based. A variety of novel therapeutics for CRPC have recently been developed and tested. When evaluating novel therapies for CRPC, there are various different endpoints that can be assessed.
Novel treatments for CRPC to be discussed include docetaxel-based combinations, new cytotoxic agents, immunotherapeutics, and targeted therapies. We evaluate prostate-specific antigen, circulating tumour cells, progression-free survival, overall survival, and other endpoints used in clinical trials.
- • Androgen-deprivation therapy is the initial treatment for metastatic prostate cancer. Although highly effective, all men who live long enough will eventually experience disease progression and develop castration resistance. Patients who have castration-resistant prostate cancer (CRPC) have a median survival of ≈1–3 years.
- • When evaluating novel therapies for CRPC, one must consider the endpoints measured for determination of response. We will discuss PSA, circulating tumour cells, progression-free survival, overall survival, and other endpoints used in clinical trials.
- • Docetaxel and sipuleucel-T are currently the preferred first-line treatment options for patients with CRPC; cabazitaxel is a new option for patients after docetaxel failure.
- • Patients with CRPC historically have very poor survival, underscoring the unmet need for novel therapeutics. Although many agents appear promising, well-designed randomized phase III trials are necessary to establish their impact on survival and health-related quality of life.
- • Promising new therapies include hormonal agents, such as abiraterone and MDV3100, as well as other novel immunotherapeutics and anti-prostate-specific membrane antigen therapies. In the future, we anticipate therapies tailored to individual patients' malignancies using various molecular analyses.