Emerging TX for mCSPC / mCRPC

Curr Opin Oncol 2013, 25:252-260

Even in Castration resistance PC ptsContinue castration still play a role

Intermittent/continuing ADT?

• Less resistance in intermittent ADT?

• No diff in the survival• Better QOL and less side effects in intermittent

group

• Continuous Tx still the mainstay treatment

Chemotherapy

• ECOG 3805• Push docetaxel from the mCRPC to CSPC

Blocking the AR pathway

• CYP17A inhibitors(abiraterone)• FDA approved for the CRPC refractory to docetaxel

Why castration resistance?

• AR amplifications/hypersensitivity• Enzalutamide >>bicalutamide in

affinity for the AR antagonist

• Docetaxel based therapy for metastatic castration resistant prostate cancer

• Combined effect drug with the docetaxel?

• Taxel combined with avastinMore death in the avastin group

• Other regimen with endothelin A antagonist, SRC inhibitors, immunomo-dulatory agents are not proved to be effective

• mCRPC refractory to the docetaxel, what would be the next drug choice?

• Cabazitaxel and abiraterone acetate

• Other novel agentsEnzalutamide

Bone target therapy

• Denosumab, antibody to the RANKL to arrest the osteoclast resorbtion and remodeling

• Denosumab vs zometa: improved skeletal related events but no change in survival

Bone target therapy

• Radium-223• Decreased bone SRE and decreased bone pain• Not shown to improved survival