Androgen receptor targeting drugs in castration-resistant prostate cancer and mechanisms of resistance

D J Crona1, M I Milowsky2,3, Y E Whang2,3

  • 1Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA.

Insights

New therapies targeting androgen receptor (AR) signaling are crucial for castration-resistant prostate cancer (CRPC). Novel agents show promise in overcoming resistance mechanisms, potentially improving patient outcomes.

Area of Science:

  • Oncology
  • Molecular Biology
  • Urology

Background:

  • Reactivated androgen receptor (AR) signaling is a key driver of castration-resistant prostate cancer (CRPC).
  • Current AR-targeting drugs like abiraterone and enzalutamide improve survival but resistance eventually develops.
  • Mechanisms of resistance include AR splice variants (e.g., AR-V7), AR mutations (e.g., F876L, T877A), and alterations in androgen biosynthesis or glucocorticoid receptor.

Purpose of the Study:

  • To review emerging therapeutic strategies for overcoming resistance in CRPC.
  • To highlight novel agents and biomarkers that may improve treatment efficacy.
  • To discuss the role of AR signaling and its resistance mechanisms in CRPC progression.

Main Methods:

  • Review of current literature on CRPC treatment resistance.
  • Analysis of novel therapeutic agents targeting AR signaling pathways.
  • Evaluation of biomarkers, such as AR-V7, for patient stratification.

Main Results:

  • Novel agents like galeterone (AR protein degradation) and EPI-001 (AR splice variant inhibition) show potential against resistance mechanisms.
  • Galeterone is being evaluated in AR-V7 positive CRPC patients.
  • AR-V7 is identified as a promising biomarker for treatment selection.

Conclusions:

  • Emerging therapies targeting AR signaling offer new hope for CRPC patients.
  • Understanding and overcoming AR-mediated resistance is critical for improving survival.
  • Novel biomarkers like AR-V7 can guide personalized treatment strategies in CRPC.

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