Recent advances in the management of metastatic prostate cancer: optimizing use of existing therapies, while searching for novel interventions

Summarizes recent advances in the treatment of metastatic castration-sensitive and castration-resistant prostate cancer.

New randomized data suggest a survival advantage to early abiraterone in castration-sensitive metastatic prostate cancer. Prospective and retrospective studies are examining sequencing of existing cytotoxic and androgen-receptor-targeted therapies in both castration-sensitive and castration-resistant disease. Genomic analysis of both circulating tumor cells and circulating tumor nucleic acids is being examined as a potential method for selecting existing therapies and identifying novel therapeutic targets. Finally, immunotherapy combinations are being evaluated in the setting of advanced prostate cancer.

In this review, we hope to summarize the recent data supporting the use of early abiraterone in castration-sensitive metastatic prostate cancer and discuss how this data might be incorporated with previous trials showing a survival advantage to early docetaxel. We present recent series examining sequencing of approved therapies as well as trials evaluating novel biomarkers and genomic analyses designed to help choose from among approved therapies or evaluate drugs in development. Lastly, we review ongoing trials examining novel immunotherapy combinations in advanced prostate cancer.

Current opinion in oncology. 2018 Mar 16 [Epub ahead of print]

Theodore Gourdin

Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.