Recent Advances Revolutionize Treatment of Metastatic Prostate Cancer

Ravi A Madan; Philip M Arlen

Disclosures

Future Oncol. 2013;9(8):1133-1144. 

In This Article

Abstract and Introduction

Abstract

In 2004, the chemotherapy agent docetaxel was approved for the treatment of metastatic prostate cancer. Although it has taken almost a decade, significant new advances have been made in this area, including the clinical development of modern hormonal therapies, such as abiraterone and enzalutamide, and immunotherapies, such as sipuleucel-T, all of which have improved survival in metastatic prostate cancer. These agents have not only provided new therapeutic options for patients with advanced disease, they have also spurred research in both androgen receptor-targeting therapy and immunotherapy. Future trials will focus on the optimal sequence of these and other emerging therapies, with the aim of using these treatments earlier in the disease course (including the adjuvant setting) to enhance clinical benefit and potentially increase the cure rate for prostate cancer.

Introduction

In 2004, docetaxel became the first chemotherapy agent to extend survival for men with metastatic castration-resistant prostate cancer (mCRPC).[1,2] While docetaxel was a significant advance in the treatment of mCRPC, ensuing years brought no additional novel therapies. Numerous studies evaluated docetaxel-based combinations and/or emerging targeted molecular therapies to no avail. These included trials with sunitinib, sorafenib, zibotentan, dasatinib, calcitriol, bevacizumab and aflibercept alone or in combination with docetaxel.[3–9] Failure to show enhanced clinical benefit in spite of additional potential toxicity has limited the enthusiasm for such trials. Not until 2010 was cabazitaxel, another taxane, found to improve survival in patients who had already been treated with docetaxel. Although cabazitaxel became the first second-line therapy to improve survival for men with mCRPC, enthusiasm for cabazitaxel was tempered by the level of neutropenia seen in study patients and by the 5% of patients who died from neutropenia-related complications.[10] Hopes were raised again by modern hormonal therapies and immunotherapies, which many believe will revolutionize the treatment of mCRPC and herald an era of significant changes in the treatment of a disease that affects almost a quarter of a million men in the USA each year.[11]

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