title: Clinical implications for a treatment algorithm and differential indication to hormone therapy and chemotherapy options in metastatic castrate-resistant prostate cancer: a personal view.
abstract: Although docetaxel is still considered a mainstay of treatment in metastatic castrate-resistant prostate cancer (mCRPC), in the last few years, new agents have been developed to improve survival in this setting and reach a possible optimal personalized treatment strategy. In this paper, we provide a personal view and an algorithm for mCRPC patients, according to available evidence, personal opinion and experience. Abiratone acetate, cabazitaxel, radium-223, sipuleucel-T and enzalutamide, together with docetaxel, have demonstrated a survival benefit in these patients. The use of rechallenge with docetaxel in mCRPC patients with disease progression after a first response has been considered. These new agents complicated the scenario and posed the challenge to move from the old sequential to a new algorithm-based approach. At this stage, the algorithm is necessarily based on experts' opinion, since the efficacy of a single agent in a specific setting has not been validated by sequential trials.
authors.affiliation: Department of Oncology, U.O.C. of Medical Oncology, USL-8, Istituto Toscano Tumori (ITT), Ospedale San Donato, Arezzo, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bracarda
authors.forename: Michele
authors.initials: M
authors.lastname: Sisani
authors.forename: Francesca
authors.initials: F
authors.lastname: Marrocolo
authors.forename: Alketa
authors.initials: A
authors.lastname: Hamzaj
authors.forename: Sabrina
authors.initials: S
authors.lastname: Del Buono
authors.forename: Amelia
authors.initials: A
authors.lastname: Altavilla
mesh_terms: D000465:Algorithms; D000726:Androgen Antagonists / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000077143:Docetaxel; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008297:Male; D064129:Prostatic Neoplasms, Castration-Resistant / Q000175:diagnosis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D043823:Taxoids / Q000627:therapeutic use; D014020:Tissue Extracts / Q000627:therapeutic use
chemical_list: D000726:Androgen Antagonists; D000970:Antineoplastic Agents; D043823:Taxoids; D014020:Tissue Extracts; D000077143:Docetaxel; C511774:sipuleucel-T
keywords: abiraterone acetate; androgen-deprivation therapy; cabazitaxel; castration-resistant prostate cancer; docetaxel; enzalutamide; radium-223; treatment algorithm