[Sequential therapy for asymptomatic or mildly symptomatic metastatic castration-resistant prostate cancer]

Abiraterone acetate (in combination with prednisone/prednisolone (abiraterone/P)), enzalutamide or docetaxel may all be used for the first-line treatment of asymptomatic or mildly symptomatic mCRPC. As treatment with docetaxel can result in the emergence of considerable adverse events, the less toxic substances abiraterone/P and enzalutamide are important alternatives. Apart from the safety and clinical effectiveness of these therapies, their optimal sequencing can play a significant role when choosing a mCRPC first-line therapy. Until recently, only retrospective trials were conducted, investigating the sequential use of abiraterone/P and enzalutamide in asymptomatic or mildly symptomatic mCRPC. However, the British Columbia Cancer Agency (BCCA) has now published results from a phase II randomised cross-over trial, which directly compared the safety and efficacy of abiraterone/P and enzalutamide in the first and second line.