Hormonal treatment of metastatic castration‑resistant prostate cancer

03/2017

MUDr. Otakar Čapoun, FEBU

Urologická klinika 1. LF UK a VFN, Praha

SUMMARY

Castration-resistant prostate cancer is a heterogeneous disease, which maintains a dependence of tumor cells to hormonal stimulation. In the case of a failure of the first-line testosterone-lowering therapy one of the next options are new hormonal agents (abiraterone, enzalutamide). Enzalutamide proved to be more effective in the second-line treatment than commonly used bicalutamide. Subanalysis of an abiraterone trial shows that the greatest benefit from the second-line hormonal therapy have patients with low levels of prostate-specific antigen, minimal pain and more differentiated tumors. However, higher Gleason score should not affect the choice of the second-line treatment. Extended follow-up in the trial with enzalutamide before chemotherapy confirmed the efficacy of this drug. The duration of a prior castration therapy has only a minimal impact on the efficacy of abiraterone in the second-line hormonal therapy. Patients receiving corticosteroids concurrently with enzalutamide in the post-docetaxel trial had generally poorer survival outcomes, however enzalutamide always demonstrated superior efficacy in comparison with placebo. Questions about sequence of treatment in the third and additional lines have not yet been resolved. The future of new hormonal agents lies in their using within the first-line hormonal therapy or adjuvantly to a radical treatment.

KEY WORDS

castration-resistant prostate cancer, abiraterone, enzalutamide