ESMO E-Learning: Metastatic Castrate-Resistant Prostate Cancer Treatment (mCRPC)

Learning Objectives

  • To provide an overview of available first-line treatments that represent standard of care in patients with metastatic castrate-resistant prostate cancer (mCRPC)  
  • To provide an overview of new hormonal drugs under development, immunotherapy approaches and targeted agents of relevance for patients with mCRPC
  • To critically analyse lessons learned from failed clinical trials in patients with mCRPC 
Title Duration Content CME Points CME Test
Metastatic Castrate-Resistant Prostate Cancer Treatment (mCRPC) 46 min. 84 slides 1 Take Test
Fabricio Racca
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Since 2010, a plethora of clinical trials have shown benefit in patients with metastatic castrate-resistant prostate cancer (mCRPC). In this E-Learning module, the author provides an overview of results from clinical trials with androgen biosynthesis inhibitors (abiraterone acetate), second generation antiandrogens (enzalutamide), docetaxel and radium 223 that set the standard therapeutic scenario in the management of mCRPC.

Furthermore, the author reviews novel hormonal therapies, namely CYP 17 inhibitor and androgen receptor (AR) antagonists (ODM-204, VT-464), second generation antiandrogens (ODM-201), and N-terminus AR selective blocker (EPI-506).

In terms of immunotherapy, the author provides an overview of active immunotherapy approaches where tumour associated antigens play an important role, passive immunotherapy with antibodies to specific receptors/antigens and immune checkpoint inhibition strategies to maintain activated tumour specific T-cells by neutralising co-inhibitory receptors.

In terms of novel targeted therapies, the author reviews recent clinical trials with PARP inhibitors oliparib and veliparib and ongoing trials in mCRPC with PI3K inhibitors testing.

The last segment of this module is dedicated to the analysis of failed clinical trials, in particular those with docetaxel combinations, tasquinimod, orteronel and ipilimumab.

The author concludes that identifying the best treatment for each patient is an unmet clinical objective in mCRPC. Further studies are needed to develop biomarkers of response to different therapies. Precision medicine may be the future for prostate cancer treatment algorithms if we are able to integrate all the epigenetic changes. The author underlines that we should also not forget that tumour stroma appears to have an important role in the evolution of prostate cancer.

Last update: 27 March 2018

The author has reported no conflicts of interest