crpc/cspc tx in 2013

1. Emerging TX for mCSPC / mCRPC
Curr Opin Oncol 2013, 25:252-260

2. Even in Castration resistance PC pts
Continue castration still play a role

3. Intermittent/continuing ADT?
• Less resistance in intermittent ADT?
• No diff in the survival
• Better QOL and less side effects in
intermittent group
• Continuous Tx still the mainstay treatment

4. Chemotherapy
• ECOG 3805
• Push docetaxel from the mCRPC to CSPC

5. Blocking the AR pathway
• CYP17A inhibitors(abiraterone)
• FDA approved
for the CRPC refractory to docetaxel

6. Why castration resistance?
• AR amplifications/hypersensitivity
• Enzalutamide >>bicalutamide in affinity for
the AR antagonist

7. • Docetaxel based therapy for metastatic
castration resistant prostate cancer
• Combined effect drug with the docetaxel?

8. • Taxel combined with avastin
More death in the avastin group
• Other regimen with endothelin A
antagonist, SRC inhibitors, immunomo-dulatory
agents are not proved to be
effective

9. • mCRPC refractory to the docetaxel, what
would be the next drug choice?
• Cabazitaxel and abiraterone acetate
• Other novel agents
Enzalutamide

10. Bone target therapy
• Denosumab, antibody to the RANKL to arrest
the osteoclast resorbtion and remodeling
• Denosumab vs zometa:
improved skeletal related events but no
change in survival

11. Bone target therapy
• Radium-223
• Decreased bone SRE and decreased bone pain
• Not shown to improved survival