title: [Choice of new drugs in castration-resistant prostate cancer: predictive factors and effectiveness assessment].
abstract: BACKGROUND
  Docetaxel has been the cornerstone in the treatment of castration- resistant prostate cancer (CRPC) since 2004. The recent and almost simultaneous arrival of new and effective molecules - several of which are already available on the market - has added to the CRPC treatment arsenal. Several studies have explored the optimal order in which these new treatments should be administered. The aim of this review was to present their respective predictive and evaluative factors and suggest potential administration sequences.
  
  
  METHODS
  The PubMed medical literature citations database was searched using the following key words: prostate cancer, castration resistant, metastatic, targeted therapy, treatment sequence, immunotherapy and clinical trials. The reports of the most recent European and North American congresses were also included.
  
  
  RESULTS
  While no predictive factors have been clearly identified for these new therapies to date, a Gleason score of not less than 8 and one or more chemotherapy sessions seemed to be predictive of lower efficacy for abiraterone. Promising elements for further investigation include the circulating tumour cell count and variation in this count per treatment, ERG mutation status or the intratumoural androgen status. Substitution criteria have not yet been reported but, as is the case with all hormone therapies, changes in PSA levels emerge as a valuable indicator of the efficacy of abiraterone. The best treatment sequence for patients who develop castration-resistance remains to be defined.
  
  
  CONCLUSIONS
  Although new molecules have recently become available, the experience with their use is limited. Thus, no predictive markers of response rates and treatment outcomes or data concerning the best treatment sequence to use in patients with CRPC are as yet available.
authors: Service d'urologie, CHU Saint-Louis, 1 av Claude-Vellefaux, 75010 Paris, France. Electronic address: victor_basset@yahoo.fr.
authors: V
authors: V
authors: Basset
authors: V
authors: V
authors: Flamand
authors: S
authors: S
authors: Crouzet
authors: G
authors: G
authors: Ploussard
mesh_terms: D000736:Androstenes; D000737:Androstenols / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D000077143:Docetaxel; D019008:Drug Resistance, Neoplasm; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D064129:Prostatic Neoplasms, Castration-Resistant / Q000097:blood / Q000188:drug therapy*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D043823:Taxoids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000736:Androstenes; D000737:Androstenols; D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D043823:Taxoids; D000077143:Docetaxel; D017430:Prostate-Specific Antigen; C089740:abiraterone
keywords: Abiraterone acetate; Acétate d’abiratérone; Biomarqueurs prédictifs; Cancer de prostate; Castration resistance; Docetaxel; Docétaxel; Enzalutamide; Predictive biomarkers; Prostate cancer; Résistance à la castration; Séquence thérapeutique; Treatment sequence