title: Evolution of the treatment paradigm for patients with metastatic castration-resistant prostate cancer.
abstract: As recently as 2004, treatment options for men with metastatic castration-resistant prostate cancer (mCRPC) were limited, with docetaxel the only approved agent conferring a survival benefit. The therapeutic landscape is now very different, with several agents demonstrating prolonged survival since 2010. New agents for the treatment of mCRPC include sipuleucel-T, cabazitaxel, abiraterone acetate, enzalutamide and radium-223. All are now approved for use in this patient group, although the specific licensing terms vary between agents. In addition, denosumab may have utility in patients with bone metastases. A number of novel agents are also in development with promising initial results. However, because these treatment options have proliferated rapidly, there is currently a paucity of clinical evidence regarding their optimal sequencing. Selection of an appropriate treatment option should take into consideration disease characteristics, drug availability and patient choice. In summary, we discuss several new treatment options available for mCRPC and their integration into the current treatment paradigm.
authors.affiliation: Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral, Merseyside, CH63 4JY, UK, Zafar.Malik@clatterbridgecc.nhs.uk.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Malik
authors.forename: Heather
authors.initials: H
authors.lastname: Payne
authors.forename: Jawaher
authors.initials: J
authors.lastname: Ansari
authors.forename: Simon
authors.initials: S
authors.lastname: Chowdhury
authors.forename: Mohammad
authors.initials: M
authors.lastname: Butt
authors.forename: Alison
authors.initials: A
authors.lastname: Birtle
authors.forename: Santhanam
authors.initials: S
authors.lastname: Sundar
authors.forename: Chinnamani Vee
authors.initials: CV
authors.lastname: Eswar
authors.forename: Simon
authors.initials: S
authors.lastname: Hughes
authors.forename: Amit
authors.initials: A
authors.lastname: Bahl
mesh_terms: D000368:Aged; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001549:Benzamides; D018572:Disease-Free Survival; D000077143:Docetaxel; D019008:Drug Resistance, Neoplasm; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D009570:Nitriles; D010669:Phenylthiohydantoin / Q000031:analogs & derivatives / Q000627:therapeutic use; D011379:Prognosis; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D058996:Quality Improvement; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D043823:Taxoids / Q000627:therapeutic use; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D001549:Benzamides; D009570:Nitriles; D043823:Taxoids; D000077143:Docetaxel; D010669:Phenylthiohydantoin; C552428:cabazitaxel; C540278:enzalutamide