Since 2010, several new agents have joined the armamentarium for the treatment of metastatic castration-resistant prostate cancer (mCRPC) (Figure 1).1–7 This had dramatically improved the outcome for patients with mCRPC, but also confronts physicians with the question of how to optimally sequence the different therapeutic options. In addition to this, the increasing use of abiraterone acetate (AA) and docetaxel (and in the near future perhaps also enzalutamide) in the castration-sensitive metastatic prostate cancer (PCa) setting will further complicate this therapeutic sequencing. During BMUC 2019, dr. Silke Gillessen gave an overview of the available clinical data that can be used to steer the treatment choices in the mCRPC setting. Unfortunately, none of the pivotal trials evaluating the novel treatment agents compared the experimental agent against a regimen that would be considered standard of care nowadays. Moreover, none of the trials included patients who received androgen deprivation therapy (ADT) plus AA or docetaxel in the hormone sensitive setting.
FIGURE 1. Approved systemic therapies for mCRPC.