title: Challenges in the sequencing of therapies for the management of metastatic castration-resistant prostate cancer.
abstract: Prior to 2010, docetaxel was the standard option for chemotherapy in men with metastatic castration-resistant prostate cancer (mCRPC). Today, the picture is vastly different: several additional therapies have each demonstrated a survival benefit such that we now have chemotherapy (cabazitaxel), androgen suppressive agents (abiraterone acetate and enzalutamide), a cellular vaccine (sipuleucel-T) and radium-233 (for symptomatic bone metastases). With several other agents in the pipeline for late-stage disease, the future looks promising for mCRPC. As the available data are not able to inform as to the optimum sequencing of therapy, this remains a challenge. This paper draws on insights from published and ongoing clinical studies to provide a practical patient-focused approach to maximize the benefits of the current therapeutic armamentarium. Preliminary sequencing suggestions are made based on clinical trial criteria. But until more data become available, clinical gestalt, experience, cost and individual patient preferences will continue to drive choices.
authors.affiliation: Medical Oncology, Box Hill Hospital, Box Hill, Victoria, Australia; Faculty of Medicine, Monash University, Melbourne, Australia.
authors.forename: Phillip
authors.initials: P
authors.lastname: Parente
authors.forename: Francis
authors.initials: F
authors.lastname: Parnis
authors.forename: Howard
authors.initials: H
authors.lastname: Gurney
mesh_terms: D000069501:Abiraterone Acetate; D000736:Androstenes / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D019496:Cancer Vaccines / Q000008:administration & dosage*; D000077143:Docetaxel; D006801:Humans; D008297:Male; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D011883:Radium / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D043823:Taxoids / Q000008:administration & dosage; D014020:Tissue Extracts / Q000008:administration & dosage
chemical_list: D000736:Androstenes; D019496:Cancer Vaccines; D043823:Taxoids; D014020:Tissue Extracts; D000077143:Docetaxel; C552428:cabazitaxel; C511774:sipuleucel-T; D000069501:Abiraterone Acetate; D011883:Radium
keywords: abiraterone acetate; cabazitaxel; enzalutamide; innovative therapy; prostate cancer