Therapeutic Options for First-Line Metastatic Castration-Resistant Prostate Cancer: Suggestions for Clinical Practise in the CHAARTED and LATITUDE Era
A partir des données des essais cliniques récents, cette étude fait le point sur les diverses stratégies thérapeutiques de première ligne pour traiter des patients attteints d'un cancer de la prostate résistant à la castration et de stade métastatique
Prostate cancer is a major health issue in Western countries, representing the most frequent tumour and the second leading cause of cancer-related deaths among males.?Several new drugs able to increase overall survival (OS) have been introduced in daily clinical practise for the management of metastatic CRPC (mCRPC). Results of randomised phase III trials showed the activity of an immunotherapeutic agent (sipuleucel-T), two new-generation hormonal treatments (abiraterone acetate [AA] and enzalutamide, an innovative taxane (cabazitaxel), and an α particle-emitting agent (radium-223).?The last three years saw a revolutionary change in the treatment paradigm of metastatic CSPC (mCSPC). Recent findings demonstrated that in patients with de novo mCSPC, the addition of chemotherapy with docetaxel (DOC) to ADT significantly improves OS compared to ADT alone. Additionally, two recent studies (LATITUDE and STAMPEDE) performed in the same disease phase established that adding AA to ADT significantly increases OS in mCSPC.?In this context, we do not have prospective data to guide decision-making in patients experiencing disease progression after DOC or AA treatment for mCSPC and we do not know how to translate previous study results into the actual treatment landscape.?This review provides an overview of the therapeutic options available to both mCSPC and mCRPC patients and offers some clinical and biological insights to select the best treatment for patients with progressive disease progression after mCSPC treatment with DOC or AA.