Medical therapy has undergone many changes as our understanding of prostate cancer cell biology has improved. Androgen deprivation therapy (ADT) remains the mainstay of therapy for metastatic disease. Metastatic castrate-resistant prostate cancer (CRPC) is an important concern since we are unable to stop progression with currently available agents. Areas covered: Pharmacologic ADT is the most commonly used treatment for metastatic prostate cancer. Multiple agents are available for both first-line and second-line use: antiandrogens, estrogens, luteinizing hormone-releasing hormone agonists/antagonists, and CYP17 inhibitors. With adoption of these drugs, it is important to consider their pharmacokinetic and pharmacodynamic properties. Many undergo metabolism through cytochrome P450. Levels may be altered with co-administration of drugs acting as enzyme inhibitors or inducers. Understanding mechanism of action, metabolism, and excretion of these drugs allows clinicians to provide the best therapeutic care while minimizing adverse events. Expert Opinion: Many men with metastatic prostate cancer will progress to castration resistance. An understanding of resistance mechanisms at the cellular level has revealed new drug targets with hopes of halting or reversing progression of metastatic disease. Second-line agents, traditionally reserved for CRPC, are being studied in metastatic castrate-sensitive prostate cancer, and may offer practice-changing evidence supporting their use.
Expert opinion on drug metabolism & toxicology. 2017 Nov 15 [Epub ahead of print]
Charles F Polotti, Christopher J Kim, Nadiya Chuchvara, Alyssa B Polotti, Eric A Singer, Sammy Elsamra
a Division of Urology , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA., b Department of Pharmacy Practice and Pharmacy Administration , University of the Sciences, Philadelphia College of Pharmacy , Philadelphia , PA , USA., c Section of Urologic Oncology , Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA.