Predicting Response and Recognizing Resistance: Improving Outcomes in Patients with Castration-Resistant Prostate Cancer

Optimal sequencing strategies for approved agents in metastatic castration-resistant prostate cancer (mCRPC) are unclear. Retrospective clinical studies suggest cross-resistance between specific therapies. This review assesses treatment decisions for mCRPC. Increased use of chemohormonal therapy in castration-sensitive disease may affect subsequent treatment decisions in mCRPC. Initial abiraterone or enzalutamide treatment may result in cross-resistance for subsequent AR-targeted therapy. Clinical responses may be seen in both docetaxel- and cabazitaxel-treated patients progressing after treatment with abiraterone or enzalutamide. These observations are supported by proposed resistance mechanisms. In conclusion, small, retrospective studies suggest cross-resistance between specific therapies in mCRPC. Larger prospective studies are required.

Urology. 2017 Aug 07 [Epub ahead of print]

Neal Shore, Axel Heidenreich, Fred Saad

Carolina Urologic Research Center, Myrtle Beach, SC. Electronic address: ., University of Cologne, Cologne, Germany., Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.