Management of Castration-Resistant, Taxane-Resistant Prostate Cancer

Metastatic castration-resistant prostate cancer that is progressing despite docetaxel chemotherapy is difficult to treat and often aggressive. If not previously used, modern androgen signaling inhibitors have established clinical activity in this setting. Cabazitaxel and radium-223 have also been shown to extend survival in appropriately selected patients. Carboplatin-containing chemotherapy regimens have not been studied in randomized trials with a survival endpoint, but they have demonstrated activity in phase II trials and are occasionally considered in the post-docetaxel setting. Recent identification of potentially exploitable targets in the molecular makeup of advanced prostate cancer has created opportunities for clinical trials of novel targeted agents, with poly(ADP-ribose) polymerase inhibitors yielding compelling early results in molecularly selected patients. Much remains to be done to improve the lot of patients with docetaxel-unresponsive metastatic castration-resistant prostate cancer.