What do we know about treatment sequencing of abiraterone, enzalutamide, and chemotherapy in metastatic castration-resistant prostate cancer?

To present a systematic review of the different therapeutic sequences in metastatic castration-resistant prostate cancer (mCRPC).

Evidence acquisition on therapeutic sequences in mCRPC was performed by a MEDLINE search using combination of the following key words: "prostate cancer," "metastatic," "castration resistant," "enzalutamide," "abiraterone," "treatment sequencing," "cabazitaxel," "docetaxel.

" A total of 17 studies were included for analysis.

Different sequences have been reported for the treatment of mCRPC: docetaxel after abiraterone, cabazitaxel after docetaxel and abiraterone, abiraterone after cabazitaxel and docetaxel, abiraterone after docetaxel and enzalutamide, and enzalutamide after docetaxel and abiraterone. There are arguments from the preclinical observations suggesting a cross-resistance between docetaxel and abiraterone, and between abiraterone and enzalutamide in mCRPC. Despite limitations, several retrospective clinical reports support these data.

No study of high level of evidence is available to support any recommendation on sequential treatment for mCRPC. There are only clues that prospective clinical studies need to confirm.

World journal of urology. 2015 Sep 15 [Epub ahead of print]

Souhil Lebdai, Victor Basset, Julien Branchereau, Alexandre de La Taille, Vincent Flamand, Thierry Lebret, Thibaut Murez, Yann Neuzillet, Guillaume Ploussard, François Audenet

Department of Urology, University Hospital of Angers, 4, rue Larrey, 49933, Angers, France. Department of Urology, Assistance publique - Hôpitaux de Paris (AP-HP), Hopital Saint Lois, Paris, France. , Department of Urology, CHU Nantes Hôtel Dieu, Nantes, France. , Department of Urology, Assistance publique - Hôpitaux de Paris (AP-HP), Hôpital Henri Mondor, Université Paris XII Val de Marne, Créteil, France. , Department of Urology, Lille University Hospital, Lille Nord de France University, Lille, France. , Department of Urology, Foch Hospital, Université Versailles St Quentin en Yvelines, Suresnes, France. , Department of Urology, Hôpital Lapeyronie, Montpellier, France. , Department of Urology, Foch Hospital, Université Versailles St Quentin en Yvelines, Suresnes, France. , Department of Urology, Assistance publique - Hôpitaux de Paris (AP-HP), Paris, France. , Department of Urology, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France.

PubMed