New options after standard hormone therapy has failed


We apparently managed to overlook a series of three review and commentary articles published in Oncology in May this year that dealt with the evolving options that have already — or will soon — come available for the treatment of castration-resistant prostate cancer (CRPC). The full texts of these articles are a useful resource for support group leaders and educators, as well as for patients with later stage forms of prostate cancer.

In the main review article by Ruch and Hussain, the authors provide a thorough overview of the spectrum of new products recently approved and in later stage clinical trials for the treatment of non-metastatic and/or metastatic CRPC. The only key product-type not covered in the article is the α-particle-emitting, radiotherapeutic agent radium-223 chloride (Alpharadin®) that has recently demonstrated a small survival benefit compared to placebo in men with metastatic CRPC. The article does not, obviously, include all of the very latest data on all relevant products, but it certainly gives a sound summary that would be very useful for a high proportion of men with progressive disease who needed to think hard about “what to do next” after standard hormone therapies had clearly failed.

Perhaps of even greater interest for the more knowledgeable student, however, are the two commentary articles, by Dorff and Pinski and by Petrylak. In these two commentaries on the primary review, the authors lay out a series of questions addressing what we will need to know before we can resolve some fundamental issues about the most appropriate use and sequencing of treatment with all the new agents.

The appropriate management of late-stage prostate cancer in a specific individual is going to become very complicated over the next few years. There really is a danger that physicians’ and patients’ preconceptions may make it difficult for us to conduct some critically important clinical trials that may help to resolve some of those questions. And there are very real issues about the absence of approved biologic markers that can help us to monitor trial endpoints in a helpful manner.

We are also pleased to note that Dorff and Pinski emphasize the need for future trials of new agents in the management of later stage prostate cancer to include, de rigeur, assessment of quality of life outcomes and not just survival. We also see this as a critical factor in understanding the real clinical value of all these new agents for the future.

2 Responses

  1. Mike

    Thanks for posting that with the links. Interesting reading.

  2. Such a great article it was, in which the authors provide a thorough overview of the spectrum of new products recently approved and in later stage clinical trials for the treatment of non-metastatic and/or metastatic CRPC. The appropriate management of late-stage prostate cancer in a specific individual is going to become very complicated over the next few years. Thanks for sharing this article.

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