Expert opinion on first-line therapy in the treatment of castration-resistant prostate cancer


Por: Maroto, P, Solsona, E, Gallardo, E, Mellado, B, Morote, J, Arranz, JA, Gomez-Veiga, F, Unda, M, Climent, MA, Alcaraz, A

Publicada: 1 abr 2016
Resumen:
Treatment of metastatic castration-resistant prostate cancer (mCRPC) has been revolutionized in recent years. It is well known that androgen receptor is still active in most patients with disease progression and serum testosterone levels <50 ng/dL. Moreover, further hormonal maneuvers, either through decreasing androgen levels (abiraterone) or by targeting the androgen receptor (AR) pathway (enzalutamide), prolong survival. In addition, a new cytostatic able to overcome docetaxel resistance, cabazitaxel, and the radioisotope radium 223 have been incorporated to the armamentarium of mCRPC. mCRPC is not only a heterogeneous tumor, it changes over time developing neuroendocrine features or selection of clones resistant to hormonal maneuvers. In addition, the multiplicity of current treatments, make it necessary to design algorithms that help the specialist to choose the most appropriate treatment for a particular patient. The lack of randomized trials comparing face to face the different available options limit the scope of this review. In this article, the authors describe the prognostic factors for first line therapy in patients with mCRPC, and propose a treatment algorithm for mCRPC based on the levels of scientific evidence available and, if not available, on the consensus between medical professionals. Finally, the panel discuss how to define progressive disease in the setting of mCRPC and treatment with targeted therapies. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Filiaciones:
Maroto, P:
 Hosp Santa Creu & Sant Pau, Dept Oncol, Barcelona 08025, Spain

Solsona, E:
 Inst Valenciano Oncol, Dept Urol, Valencia, Spain

Gallardo, E:
 Parc Tauli Sabadell Hosp Univ, Dept Oncol, Barcelona, Spain

Mellado, B:
 Hosp Clin Barcelona, Dept Med Oncol, Barcelona, Spain

Morote, J:
 Hosp Vall diHebron, Dept Urol, Barcelona, Spain

Arranz, JA:
 Hosp Gen Univ Gregorio Maranon, Dept Oncol, Madrid, Spain

Gomez-Veiga, F:
 Hosp Univ Salamanca, Dept Urol, Salamanca, Spain

Unda, M:
 Hosp Basurto, Dept Urol, Bilbao, Spain

Climent, MA:
 Inst Valenciano Oncol, Dept Urol, Valencia, Spain

Alcaraz, A:
 Hosp Clin Barcelona, Dept Urol, Barcelona, Spain
ISSN: 10408428





CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY
Editorial
ELSEVIER SCIENCE INC, STE 800, 230 PARK AVE, NEW YORK, NY 10169 USA, Estados Unidos America
Tipo de documento: Review
Volumen: 100 Número:
Páginas: 127-136
WOS Id: 000373543900015
ID de PubMed: 26363809

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