The Evolving Systemic Treatment Landscape for Patients with Advanced Prostate Cancer.

Prostate cancer (PC) is a major health issue in developed countries, with, on the one hand, men suffering from sequelae related to unnecessary treatment of non-lethal PC, and, on the other hand, still dying because of advanced PC that progresses to castration-resistant disease. Systemic treatment is the mainstay of therapy of castration-resistant PC (CRPC). To date, a multitude of systemic agents have been tested and many of these have failed to provide a clinically meaningful benefit in CRPC, while others have been approved by the US Food and Drug Administration and/or the European Medicines Agency, including antiandrogen hormonal drugs (abiraterone, enzalutamide, apalutamide), chemotherapy (docetaxel and cabazitaxel), immunotherapy (Sipuleucel-T), and radiopharmaceutical (Radium-223) agents. In this review, systemic treatments regarded as most likely to have an impact in clinical practice are presented and discussed. In addition to the pivotal clinical studies, selected retrospective and non-randomized clinical trials are also discussed if deemed to have an impact on clinical practice or future research. A comprehensive appraisal of the expanding landscape of systemic therapies for advanced PC is provided from an expert perspective, with a focus on novel classification and diagnostic tools that have been paving the way for the development of precision medicine in PC.

Drugs. 2019 Feb 11 [Epub ahead of print]

Martina Pagliuca, Carlo Buonerba, Karim Fizazi, Giuseppe Di Lorenzo

Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy., Institut Gustave Roussy, University of Paris Sud, Villejuif, France., Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy. .

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