How to approach sequencing therapy in patients with metastatic castration resistant prostate cancer

Rapid progress has recently been made in understanding the biology of advanced prostate cancer. This has translated into the development of a number of novel agents to treat metastatic castration resistant prostate cancer (mCRPC).

The relevant literature was retrieved from a search of MEDLINE with appropriate key words.

Therapeutic approaches to mCRPC include chemotherapy, hormonal manipulation, immunotherapy and radioisotope therapy. Docetaxel and cabazitaxel are cytotoxic agents which have demonstrated a modest impact on survival. Hormonal manipulation with abiraterone and enzalutamide have also been reported to be beneficial in mCRPC. The radioisotope radium 223 utilizes a novel approach in treating mCRPC and was recently described in a positive phase III trial. Finally, sipuleucel-T is an immunotherapy that has a demonstrated overall survival benefit in mCRPC.

A number of phase III trials have been published that describe agents which are beneficial in treating mCRPC. Future research will focus on sequencing these agents in a clinically rational and economically viable manner.