TY - JOUR
T1 - Charting Recent Progress and Challenges in Metastatic Castration-resistant Prostate Cancer
T2 - Is There an Optimal Treatment Sequence?
AU - Oudard, Stéphane
AU - Maroto, Pablo
AU - Demonty, Gaston
AU - Gerritsen, Winald R.
N1 - Funding Information:
Funding/Support and role of the sponsor: The authors thank Kim Allcott (PhD) of Oxford PharmaGenesis Ltd. who provided medical writing support. Funding for this medical writing support was provided by Amgen (Europe) GmbH. Editorial support was provided by Emma Booth and Sarah Petrig of Amgen (Europe) GmbH.
Publisher Copyright:
© 2016
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Context Recent developments in the treatment of metastatic castration-resistant prostate cancer (mCRPC) have led to uncertainty about the optimal sequence of agents. Objective To review and assess treatment options and sequence in patients with mCRPC. Evidence acquisition To identify data on the optimal use of approved treatments, we searched PubMed for studies on the use of recently approved agents for men with mCRPC published before March 2015. Phase 3 and other key studies were included in the review of efficacy and safety. In this review, we offer our critical interpretation of potential treatment sequences for drug use in the light of our clinical experience. Evidence synthesis Since 2004, the treatment landscape for mCRPC has changed dramatically following the approval of docetaxel, abiraterone acetate, enzalutamide, cabazitaxel, denosumab, and radium-223 chloride. To date, only small-scale studies have been undertaken that provide evidence on the sequencing of these treatments. Ideally, randomised, prospective studies would evaluate different sequence options thoroughly so that physicians could make evidence-based decisions, but the number of new agents makes this impractical. When deciding which treatment to prescribe, physicians will need to use the available evidence combined with their own clinical judgement. The potential for cross-resistance between taxanes and hormonal therapies and the possibility that patients might not be suitable for aggressive therapies in later lines should be taken into account. Prevention of complications associated with bone metastases should also be a key consideration because of the major impact these events have on quality of life and healthcare costs. Conclusions The recent approval of numerous new agents has resulted in considerable improvements in outcomes for patients with mCRPC. Further studies determining the optimal treatment algorithm, in addition to open discussion of best practice among physicians, are required to ensure patients obtain the maximum possible benefit from their treatment. Patient summary In recent years a large number of new treatment options have been approved for use in men with prostate cancer. In the absence of clinical trials assessing the use of one option versus another in specific patient groups, it is important to review the currently published evidence to try to understand patients receive the best treatment options in the correct order.
AB - Context Recent developments in the treatment of metastatic castration-resistant prostate cancer (mCRPC) have led to uncertainty about the optimal sequence of agents. Objective To review and assess treatment options and sequence in patients with mCRPC. Evidence acquisition To identify data on the optimal use of approved treatments, we searched PubMed for studies on the use of recently approved agents for men with mCRPC published before March 2015. Phase 3 and other key studies were included in the review of efficacy and safety. In this review, we offer our critical interpretation of potential treatment sequences for drug use in the light of our clinical experience. Evidence synthesis Since 2004, the treatment landscape for mCRPC has changed dramatically following the approval of docetaxel, abiraterone acetate, enzalutamide, cabazitaxel, denosumab, and radium-223 chloride. To date, only small-scale studies have been undertaken that provide evidence on the sequencing of these treatments. Ideally, randomised, prospective studies would evaluate different sequence options thoroughly so that physicians could make evidence-based decisions, but the number of new agents makes this impractical. When deciding which treatment to prescribe, physicians will need to use the available evidence combined with their own clinical judgement. The potential for cross-resistance between taxanes and hormonal therapies and the possibility that patients might not be suitable for aggressive therapies in later lines should be taken into account. Prevention of complications associated with bone metastases should also be a key consideration because of the major impact these events have on quality of life and healthcare costs. Conclusions The recent approval of numerous new agents has resulted in considerable improvements in outcomes for patients with mCRPC. Further studies determining the optimal treatment algorithm, in addition to open discussion of best practice among physicians, are required to ensure patients obtain the maximum possible benefit from their treatment. Patient summary In recent years a large number of new treatment options have been approved for use in men with prostate cancer. In the absence of clinical trials assessing the use of one option versus another in specific patient groups, it is important to review the currently published evidence to try to understand patients receive the best treatment options in the correct order.
KW - Androgen deprivation therapy
KW - Bone metastasis
KW - Bone-targeted agent
KW - Chemotherapy
KW - Immunotherapy
KW - Metastatic castration-resistant prostate cancer
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U2 - 10.1016/j.euf.2015.11.008
DO - 10.1016/j.euf.2015.11.008
M3 - Review article
C2 - 28723476
AN - SCOPUS:84995530389
SN - 2405-4569
VL - 2
SP - 426
EP - 440
JO - European Urology Focus
JF - European Urology Focus
IS - 4
ER -