Today’s post will cover a topic I have been writing about very often lately: metastatic castrate-resistant prostate cancer (MCRPC), specifically the apparent explosion of treatment options that have been either FDA approved in recent years or are still in clinical trials.

Let’s start with Sipoleucel-T, which was FDA approved for treatment of asymptomatic or minimally symptomatic MCRPC nearly two years. Since then, this immunotherapy has already made its way into the NCCN guidelines as part of first and second line therapies.  

Another treatment option for this setting is abiraterone. This drug was FDA approved a year ago based on strong survival data, and is one of only four prostate cancer drugs to ever show such a benefit. The NCCN guidelines list abiraterone as a second-line therapy for the treatment of MCRPC. Since abiraterone is a form of chemotherapy, and some oncologists prefer to try other forms of therapy prior to initiating chemo, what is the benefit of using abiraterone earlier in the disease process?    

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Before I conclude this post, I wanted to mention that there are two major therapies currently on the horizon for treatment of MCRPC: MDV-3100 and radium 223, which could be administered either pre- or post-chemo. MDV-3100, an androgen receptor antagonist, is currently in a Phase 3 trial to investigate its efficacy and safety in advanced prostate cancer patients who have never received chemotherapy, and has already shown promising survival data. Radium 223, a bone-targeting agent that has been shown to kill metastasized prostate cancer cells in bone with low toxicity, is currently in Phase 3 trials.

With all of the available and emerging treatment options for MCRPC, will docetaxel remain the standard of care?    

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