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
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