New therapeutic modalities for castrate resistant prostate cancer at the beginning of 2013


Authors: Michaela Matoušková;  Miroslav Hanuš
Authors‘ workplace: Urocentrum Praha
Published in: Ces Urol 2013; 17(3): 141-153
Category: Review article

Overview

Pharmacotherapy of castrate resistant prostate cancer (CRPC) has undergone remarkable changes within the last several decades. A crucial discovery of hormonal dependence of prostate cancer by Huggins and Hodges, in the late 1940’s, opened new therapeutic possibilities. In the 80’s, the U.S. Food and Drug Administration approved the first luteinizing hormone-releasing hormone (LHRH) agonist. These drugs have a suppressive effect on the testosterone levels in the blood, which is equivalent to an orchiectomy. Nevertheless, this method has been associated with negative side effects, such as miniflares. Also, the level of testosterone in the blood was not always sufficiently low. Despite the initial therapeutic effects and good long term response, the cancer becomes hormone resistant over time. The next notable improvement in the treatment of CRPC was introduced at the beginning of this century and it included a combination of docetaxel with prednisone, as a 1st line treatment modality for CRPC. This represented a firts new therapeutic approach which prolonged the survival of patients suffering from CRPC. Within the last decade, several new molecules have been introduced, referred to as biological drugs. These are nonsteroideal antiandrogens, such as enzalutamid, selective CYP 17 inhibitor abirateron acetate, 2nd generation taxan, cabazitaxel, and Sipuleucel T which represents a new agent active in cancer immunotherapy. Several phase II and III studies are currently ongoing to test additional new drugs, which are showing a promising effect. New drugs modulating the metabolism of bones in metastatic CRPC became available as well.

Key words:
castrate resistant prostate cancer (CRPC), hormonal therapy chemotherapy, targeted therapy, new drugs.


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Paediatric urologist Nephrology Urology
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