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Innovations in the systemic therapy of prostate cancer

Nature Reviews Clinical Oncology volume 7, pages 13–21 (2010)Cite this article

Abstract

Systemic therapy has become an increasingly important component of treatment of advanced prostate cancer. In the past decade, important innovations have been achieved in the development of novel systemic hormonal therapies for the salvage treatment of metastatic castrate-resistant disease. These improvements have been accompanied by the broadening of potential indications for chemotherapy in castrate-resistant metastatic disease and the use of chemotherapy as an adjunct to the treatment of locally extensive tumors. These changes have begun to lead to improved outcomes, but at the expense of novel patterns of late toxic effects. We review the key steps in the recent evolution of systemic therapy of prostate cancer.

Key Points

  • Docetaxel-based chemotherapy provides a survival benefit for patients with metastatic disease; docetaxel increased median survival from 17.5 months to 19.2 months compared with mitoxantrone

  • Survival for metastatic disease has not improved much in the past decade; however, systemic hormone suppression in association with definitive local therapy has led to improved survival in node-positive patients

  • Although systemic androgen deprivation therapy causes biochemical and clinical castration and suppresses tumor growth, tumors may continue to be stimulated by androgens produced by the adrenal gland or the tumor

  • Abiraterone acetate is a novel hormonal therapy that binds CYP17A1 and irreversibly inhibits this enzyme, which prevents androgen formation; this agent is more specific than other secondary hormonal therapies

  • Abiraterone acetate is currently being evaluated in phase I–II trials; clinical and prostate-specific antigen responses have been reported

  • Many other agents have been tested in castration-resistant prostate cancer, including atrasentan, bevacizumab, sorafenib, erlotinib, gefitinib, calcitriol and doxercalciferol, but their role and utility have not yet been defined

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  1. Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue/R35, Cleveland, 44195, OH, USA

    Dale R. Shepard & Derek Raghavan

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Correspondence to Derek Raghavan.

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Shepard, D., Raghavan, D. Innovations in the systemic therapy of prostate cancer. Nat Rev Clin Oncol 7, 13–21 (2010). https://doi.org/10.1038/nrclinonc.2009.187

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