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Maslov DV, Sember Q, Cham J, Bhangoo M. A review of treatments targeting DNA-repair gene defects in metastatic castration resistant prostate cancer. Front Oncol 2023; 13:1150777. [PMID: 36998466 PMCID: PMC10046303 DOI: 10.3389/fonc.2023.1150777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
Prostate cancer is the most common cancer in men. About 6% of those diagnosed will develop metastatic disease. Unfortunately, metastatic prostate cancer is fatal. Prostate cancer can be castration sensitive or castration resistant. Many treatments have been shown to improve progression free survival and overall survival in metastatic castration resistant prostate cancer (mCRPC). In recent years, studies have been exploring targeting mutations in the DNA Damage Repair (DDR) response that may amplify oncogenes. In this paper, we aim to discuss DDR, new approved targeted therapies, and the most recent clinical trials in the setting of metastatic CRPC.
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Affiliation(s)
- Diana V. Maslov
- Department of Hematology/Oncology, Scripps Health System, San Diego, CA, United States
- *Correspondence: Diana V. Maslov,
| | - Quinne Sember
- Department of Hematology/Oncology, Scripps Health System, San Diego, CA, United States
| | - Jason Cham
- Scripps Clinic/Green Hospital, Department of Internal Medicine, San Diego, CA, United States
| | - Munveer Bhangoo
- Department of Hematology/Oncology, Scripps Health System, San Diego, CA, United States
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2
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Zhu Y, Ye D. Chinese Expert Consensus on the Diagnosis and Treatment of Castration-Resistant Prostate Cancer (2019 Update). Cancer Manag Res 2020; 12:2127-2140. [PMID: 32273753 PMCID: PMC7103027 DOI: 10.2147/cmar.s236879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022] Open
Abstract
Currently, the basic treatment of advanced prostate cancer is still endocrine therapy, but almost all patients eventually progress to castration-resistant prostate cancer (CRPC). In 2016, the Chinese Expert Consensus on the Diagnosis and Treatment of CRPC which aimed to help Chinese clinicians formulate treatment plans for CRPC was published. In this 2019 update, the 2016 version was updated with the aim of providing a more appropriate reference for clinical practice, standardizing CRPC patient management, and facilitating decision-making. The consensus is evidence-based and reviews the optimal therapeutic recommendations for CRPC management in China by taking into consideration the clinical characteristics of Chinese patients; drug availability, efficacy and safety; and recent advancements and developments in the international medical arena.
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Affiliation(s)
- Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical School, Fudan University, Shanghai, People’s Republic of China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical School, Fudan University, Shanghai, People’s Republic of China
| | - On behalf of the Expert Group
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical School, Fudan University, Shanghai, People’s Republic of China
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Abstract
INTRODUCTION Clusterin (CLU) is a stress-activated, ATP-independent molecular chaperone, normally secreted from cells, that is up-regulated in Alzheimer disease and in many cancers. It plays important roles in protein homeostasis/proteostasis, inhibition of cell death pathways, and modulation of pro-survival signalling and transcriptional networks. Changes in the CLU gene locus are highly associated with Alzheimer disease, and many therapy-resistant cancers over-express CLU. The extensive post-translational processing and heterogeneous oligomerization of CLU have so far prevented any definitive structure determination. This in turn has meant that targeting CLU with small molecule inhibitors is challenging. Therefore, inhibiting CLU at the gene-expression level using siRNA or antisense is a valid approach to inhibit its function. Areas covered: This article reviews recent advances regarding the role of CLU in proteostasis, cellular trafficking, human diseases, and signalling pathways involved in oncogenesis. It addresses the rationale for CLU as a therapeutic target in cancer, and the current status of pre-clinical and clinical studies using CLU antisense inhibitor OGX011. Expert opinion: Discusses challenges facing the therapeutic targeting of CLU including rapid changes in the treatment landscape for prostate cancer with multiple new FDA approved drugs, selection of windows of intervention, and potential side effects when silencing CLU expression.
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Affiliation(s)
- Mark R Wilson
- a School of Biological Sciences , University of Wollongong , Wollongong , Australia
| | - Amina Zoubeidi
- b Department of Urologic Sciences, Vancouver Prostate Centre , University of British Columbia and Vancouver General Hospital , Vancouver , Canada
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van Dodewaard-de Jong JM, Santegoets SJAM, van de Ven PM, Versluis J, Verheul HMW, de Gruijl TD, Gerritsen WR, van den Eertwegh AJM. Improved efficacy of mitoxantrone in patients with castration-resistant prostate cancer after vaccination with GM-CSF-transduced allogeneic prostate cancer cells. Oncoimmunology 2016; 5:e1105431. [PMID: 27141390 PMCID: PMC4839338 DOI: 10.1080/2162402x.2015.1105431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/02/2015] [Accepted: 10/03/2015] [Indexed: 12/22/2022] Open
Abstract
Previous vaccination studies in patients with castration-resistant prostate cancer (CRPC) showed improved survival without prolongation of progression-free survival (PFS). This might be explained by enhanced efficacy of subsequent therapies because of heightened immune status. We therefore evaluated the efficacy of chemotherapy in CRPC patients after immunotherapy. We retrospectively analyzed 28 patients who were treated with ipilimumab and GVAX, an allogeneic vaccine, and 21 patients who were randomized to GVAX or no vaccination. To study whether immune status was related to the efficacy of chemotherapy, frequencies of myeloid and lymphocyte subsets were determined. Of 28 patients treated with GVAX and ipilimumab, 23 patients received docetaxel and 13 patients mitoxantrone. Median PFS after docetaxel was 6.4 mo (range 0.8-11.2), while median PFS after mitoxantrone was markedly longer than expected (4.8 mo; range 1.4-13.7). High CD8+ICOS+ Tcell/Treg and pDC/mMDSC ratios were associated with relatively long PFS after mitoxantrone, suggesting a correlation between activated immune status and benefit of mitoxantrone. Analysis of 21 patients, randomized to GVAX or not, revealed a median PFS after docetaxel of 9.9 mo for vaccinated patients and 7.1 mo for unvaccinated patients. Interestingly, PFS after mitoxantrone (n = 14) was significantly longer in vaccinated patients as compared to controls (5.9 vs. 1.6 mo, p = 0.0048). In conclusion, mitoxantrone seems more effective in CRPC patients after immunotherapy, which may be related to the immune-stimulating effect of mitoxantrone in patients with heightened antitumor immunity. As this was a retrospective study with limited sample size, prospective studies are warranted to definitively show proof of principle.
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Affiliation(s)
| | - Saskia JAM Santegoets
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Jurjen Versluis
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Henk M. W. Verheul
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Tanja D. de Gruijl
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Winald R. Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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5
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Saad F, Chi KN, Finelli A, Hotte SJ, Izawa J, Kapoor A, Kassouf W, Loblaw A, North S, Rendon R, So A, Usmani N, Vigneault E, Fleshner NE. The 2015 CUA-CUOG Guidelines for the management of castration-resistant prostate cancer (CRPC). Can Urol Assoc J 2015; 9:90-6. [PMID: 26085865 DOI: 10.5489/cuaj.2526] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Agents that have shown improvements in survival in mCRPC now include abiraterone, enzalutamide, docetaxel, cabazitaxel and radium-223. Bone supportive agents and palliative radiation continue to play an important role in the overall management of mCRPC. Given the complexity, variety and importance of optimizing the use of these agents, a multidisciplinary team approach is highly recommended.
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Affiliation(s)
- Fred Saad
- Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | | | - Antonio Finelli
- University of Toronto, Princess Margaret Cancer Centre, Toronto, ON
| | | | | | | | | | - Andrew Loblaw
- Sunnybrook Health Sciences Centre, Toronto, University of Toronto, ON
| | - Scott North
- BC Cancer Agency, Vancouver, BC; ; Cross Cancer Institute, University of Alberta, Edmonton, AB
| | - Ricardo Rendon
- Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - Alan So
- University of British Columbia, Vancouver, BC
| | - Nawaid Usmani
- Cross Cancer Institute, University of Alberta, Edmonton, AB
| | - Eric Vigneault
- l'Hotel-Dieu de Quebec, Université de Laval, Quebec City, QC
| | - Neil E Fleshner
- University of Toronto, Princess Margaret Cancer Centre, Toronto, ON
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Joly F, Delva R, Mourey L, Sevin E, Bompas E, Vedrine L, Ravaud A, Eymard JC, Tubiana-Mathieu N, Linassier C, Houede N, Guillot A, Ringensen F, Cojocarasu O, Valenza B, Leconte A, Lheureux S, Clarisse B, Oudard S. Clinical benefits of non-taxane chemotherapies in unselected patients with symptomatic metastatic castration-resistant prostate cancer after docetaxel: the GETUG-P02 study. BJU Int 2014; 115:65-73. [DOI: 10.1111/bju.12552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Florence Joly
- Medical Oncology-Clinical Research Department; Centre François Baclesse - CHU Côte de Nacre; Caen France
- Universite Basse Normandie; Caen France
| | - Remy Delva
- Medical Oncology; Institut de Cancérologie de l'Ouest Centre Paul Papin; Angers France
| | - Loïc Mourey
- Medical Oncology; Institut Claudius Régaud; Toulouse France
| | - Emmanuel Sevin
- Medical Oncology-Clinical Research Department; Centre François Baclesse - CHU Côte de Nacre; Caen France
| | | | | | - Alain Ravaud
- Medical Oncology; Hôpital Saint-André; Bordeaux France
| | | | | | | | - Nadine Houede
- Medical Oncology; Institut Bergonié; Bordeaux France
| | - Aline Guillot
- Institut de Cancérologie de la Loire; Saint-Etienne France
| | | | | | - Bruno Valenza
- Oncology-Hematology; Centre Hospitalier; Frejus France
| | | | - Stéphanie Lheureux
- Medical Oncology-Clinical Research Department; Centre François Baclesse - CHU Côte de Nacre; Caen France
| | | | - Stéphane Oudard
- Medical Oncology Department; Georges Pompidou Hospital; Paris France
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7
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Saad F, Hotte S, Catton C, Drachenberg D, Finelli A, Fleshner N, Gleave M, Kapoor A, Kassouf W, Loblaw A, North S, Usmani N, Chi KN. CUA-CUOG guidelines for the management of castration-resistant prostate cancer (CRPC): 2013 update. Can Urol Assoc J 2013; 7:231-7. [PMID: 24032056 DOI: 10.5489/cuaj.1542] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Fred Saad
- Division of Urologic Oncology Centre Hospitalier de l'Université de Montréal, Montréal, QC
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Abstract
Over the past few years, we have developed an increased understanding of the molecular mechanisms that underlie prostate cancer progression and castration resistance and expanded our repertoire of therapeutic options for castration-resistant prostate cancer (CRPC). Four new agents (cabazitaxel, abiraterone acetate, enzalutamide, and radium-233) have been shown to prolong overall survival in patients with CRPC in the postchemotherapy setting. Targeting the androgen receptor pathway continues to have an important role in the treatment of CRPC, with abiraterone acetate and enzalutamide being the most exciting developments. Cabazitaxel is now considered the standard-of-care second-line chemotherapy for men with metastatic CRPC (mCRPC). Bone-targeted therapy is an active area of research, with denosumab being the first bone-targeted agent able to significantly delay the appearance of bone metastases in patients with CRPC and radium-223 being the first radiopharmaceutical agent to improve survival in patients with mCRPC.
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Wirth M, Heidenreich A, Gschwend JE, Gil T, Zastrow S, Laniado M, Gerloff J, Zühlsdorf M, Mordenti G, Uhl W, Lannert H. A multicenter phase 1 study of EMD 525797 (DI17E6), a novel humanized monoclonal antibody targeting αv integrins, in progressive castration-resistant prostate cancer with bone metastases after chemotherapy. Eur Urol 2013; 65:897-904. [PMID: 23791392 DOI: 10.1016/j.eururo.2013.05.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/28/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND EMD 525797 (DI17E6) is a deimmunized, humanized monoclonal immunoglobulin G2 antibody against the αv subunit of human integrins. Blocking αv integrins may be an effective strategy for inhibiting prostate cancer (PCa) metastasis. OBJECTIVE Evaluate EMD 525797 safety/tolerability and pharmacokinetics (PK) in castration-resistant PCa patients. Secondary objectives included antitumor activity assessments. DESIGN, SETTING, AND PARTICIPANTS A phase 1 open-label study in 26 patients (four European centers). Eligible patients (≥ 18 yr) had histologically proven PCa with bone metastases after prior chemotherapy and evidence of progressive disease (PD) based on prostate-specific antigen (PSA) values. INTERVENTION Patients received three intravenous EMD 525797 infusions (250, 500, 1000, or 1500 mg every 2 wk). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Treatment-emergent adverse events (TEAEs) and dose-limiting toxicities (DLTs) were assessed. PK parameters were calculated according to noncompartmental standard methods. Antitumor activity measures were response after 6 wk, changes in PSA levels, and pain interference total score. Descriptive statistics were used. RESULTS AND LIMITATIONS Patients were treated for a mean of 16.8 ± 16.7 wk. No DLTs were reported in any of the cohorts. All patients experienced TEAEs, which were considered drug-related in 11 patients. Four deaths occurred during the trial and were considered not related to EMD 525797. EMD 525797 showed dose-dependent, nonlinear PK. Eighteen of 26 patients did not show PD for ≥ 18 wk. Two patients (500-mg cohort), treated for 42.4 and 76.3 wk, had clinically significant PSA reductions and pain relief, including one patient with confirmed partial response. This trial was not specifically designed to assess clinical activity, and further investigations are needed in randomized controlled trials. CONCLUSIONS No DLTs were reported in any of the evaluated cohorts. There was evidence of clinical activity. For the currently ongoing phase 2 trial, EMD 525797 doses of 750 and 1500 mg every 3 wk were chosen. TRIAL REGISTRATION NCT00958477 (EMR 62242-002).
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Affiliation(s)
- Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.
| | | | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich Klinikum Rechts der Isar, Munich, Germany
| | - Thierry Gil
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan Zastrow
- Department of Urology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Michael Laniado
- Department of Urology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
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Fenoglio D, Traverso P, Parodi A, Tomasello L, Negrini S, Kalli F, Battaglia F, Ferrera F, Sciallero S, Murdaca G, Setti M, Sobrero A, Boccardo F, Cittadini G, Puppo F, Criscuolo D, Carmignani G, Indiveri F, Filaci G. A multi-peptide, dual-adjuvant telomerase vaccine (GX301) is highly immunogenic in patients with prostate and renal cancer. Cancer Immunol Immunother 2013; 62:1041-52. [PMID: 23591981 PMCID: PMC11029691 DOI: 10.1007/s00262-013-1415-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anti-tumor vaccination is a new frontier in cancer treatment applicable to immunogenic neoplasms such as prostate and renal cancers. GX301 is a vaccine constituted by four telomerase peptides and two adjuvants, Montanide ISA-51 and Imiquimod. OBJECTIVE The aim of this study was to analyze safety and tolerability of GX301 in an open-label, phase I/II trial. Immunological and clinical responses were also evaluated as secondary endpoints. EXPERIMENTAL DESIGN GX301 was administered by intradermally injecting 500 μg of each peptide (dissolved in Montanide ISA-51) in the skin of the abdomen. Imiquimod was applied as a cream at the injection sites. The protocol included 8 administrations at days 1, 3, 5, 7, 14, 21, 35, 63. Eligible patients were affected with stage IV prostate or renal cancer resistant to conventional treatments. Patients were clinically and immunologically monitored up to 6 months from the first immunization. RESULTS No grade 3-4 adverse events were observed. Evidence of vaccine-specific immunological responses was detected in 100 % of patients. Disease stabilization occurred in 4 patients. Prolonged progression-free survival and overall survival were observed in patients showing a full pattern of vaccine-specific immunological responses. CONCLUSION GX301 demonstrated to be safe and highly immunogenic. Further studies are needed to determine its clinical efficacy.
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Affiliation(s)
- Daniela Fenoglio
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Traverso
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
- Department of Surgical Sciences, University of Genoa, Genoa, Italy
| | - Alessia Parodi
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Laura Tomasello
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Simone Negrini
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Francesca Kalli
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Florinda Battaglia
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Francesca Ferrera
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Stefania Sciallero
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Maurizio Setti
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Alberto Sobrero
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Francesco Boccardo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Giuseppe Cittadini
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Domenico Criscuolo
- Genovax srl, Colleretto Giacosa, Italy
- Present Address: Mediolanum Farmaceutici Spa, Milan, Italy
| | | | - Francesco Indiveri
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Gilberto Filaci
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
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11
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Zielinski R, Chi KN. Custirsen (OGX-011): a second-generation antisense inhibitor of clusterin in development for the treatment of prostate cancer. Future Oncol 2013; 8:1239-51. [PMID: 23130925 DOI: 10.2217/fon.12.129] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Clusterin is a stress-induced cytoprotective chaperone that confers broad-spectrum treatment resistance and is overexpressed across a number of cancers. custirsen (OGX-011) is a promising novel second-generation antisense inhibitor of clusterin in clinical development. This article describes the mechanism of action and safety profile of OGX-011 and details the Phase I and II results in human solid organ malignancies. Two Phase III registration trials are currently under recruitment evaluating OGX-011 in combination with chemotherapy in patients with metastatic castration-resistant prostate cancer. These studies not only have the potential to significantly alter the standard of care in prostate cancer, but would also endorse a new class of targets and targeted therapy approach for cancer.
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Affiliation(s)
- Robert Zielinski
- Bristish Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada
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12
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Yang DR, Ding XF, Luo J, Shan YX, Wang R, Lin SJ, Li G, Huang CK, Zhu J, Chen Y, Lee SO, Chang C. Increased chemosensitivity via targeting testicular nuclear receptor 4 (TR4)-Oct4-interleukin 1 receptor antagonist (IL1Ra) axis in prostate cancer CD133+ stem/progenitor cells to battle prostate cancer. J Biol Chem 2013; 288:16476-16483. [PMID: 23609451 DOI: 10.1074/jbc.m112.448142] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Prostate cancer (PCa) stem/progenitor cells are known to have higher chemoresistance than non-stem/progenitor cells, but the underlying molecular mechanism remains unclear. We found the expression of testicular nuclear receptor 4 (TR4) is significantly higher in PCa CD133(+) stem/progenitor cells compared with CD133(-) non-stem/progenitor cells. Knockdown of TR4 levels in the established PCa stem/progenitor cells and the CD133(+) population of the C4-2 PCa cell line with lentiviral TR4 siRNA led to increased drug sensitivity to the two commonly used chemotherapeutic drugs, docetaxel and etoposide, judging from significantly reduced IC50 values and increased apoptosis in the TR4 knockdown cells. Mechanism dissection studies found that suppression of TR4 in these stem/progenitor cells led to down-regulation of Oct4 expression, which, in turn, down-regulated the IL-1 receptor antagonist (IL1Ra) expression. Neutralization experiments via adding these molecules into the TR4 knockdown PCa stem/progenitor cells reversed the chemoresistance, suggesting that the TR4-Oct4-IL1Ra axis may play a critical role in the development of chemoresistance in the PCa stem/progenitor cells. Together, these studies suggest that targeting TR4 may alter chemoresistance of PCa stem/progenitor cells, and this finding provides the possibility of targeting TR4 as a new and better approach to overcome the chemoresistance problem in PCa therapeutics.
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Affiliation(s)
- Dong-Rong Yang
- George Whipple Laboratory for Cancer Research, Departments of Pathology, Urology, and Radiation Oncology and the Wilmot Cancer Center. University of Rochester Medical Center, Rochester, New York 14642; Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Xian-Fan Ding
- George Whipple Laboratory for Cancer Research, Departments of Pathology, Urology, and Radiation Oncology and the Wilmot Cancer Center. University of Rochester Medical Center, Rochester, New York 14642; Department of Urology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, 310016 China
| | - Jie Luo
- George Whipple Laboratory for Cancer Research, Departments of Pathology, Urology, and Radiation Oncology and the Wilmot Cancer Center. University of Rochester Medical Center, Rochester, New York 14642
| | - Yu-Xi Shan
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Ronghao Wang
- George Whipple Laboratory for Cancer Research, Departments of Pathology, Urology, and Radiation Oncology and the Wilmot Cancer Center. University of Rochester Medical Center, Rochester, New York 14642
| | - Shin-Jen Lin
- George Whipple Laboratory for Cancer Research, Departments of Pathology, Urology, and Radiation Oncology and the Wilmot Cancer Center. University of Rochester Medical Center, Rochester, New York 14642
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, 310016 China
| | - Chiung-Kuei Huang
- George Whipple Laboratory for Cancer Research, Departments of Pathology, Urology, and Radiation Oncology and the Wilmot Cancer Center. University of Rochester Medical Center, Rochester, New York 14642
| | - Jin Zhu
- George Whipple Laboratory for Cancer Research, Departments of Pathology, Urology, and Radiation Oncology and the Wilmot Cancer Center. University of Rochester Medical Center, Rochester, New York 14642; Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou, 215004 China
| | - Yuhchyau Chen
- George Whipple Laboratory for Cancer Research, Departments of Pathology, Urology, and Radiation Oncology and the Wilmot Cancer Center. University of Rochester Medical Center, Rochester, New York 14642
| | - Soo Ok Lee
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou, 215004 China.
| | - Chawnshang Chang
- George Whipple Laboratory for Cancer Research, Departments of Pathology, Urology, and Radiation Oncology and the Wilmot Cancer Center. University of Rochester Medical Center, Rochester, New York 14642; Sex Hormone Research Center, China Medical University/Hospital, Taichung 404, Taiwan.
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13
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Abstract
Treatment options for castration-resistant prostate cancer (crpc) have evolved since the start of the 2000s, with most of the new effective therapies appearing since 2010. In 2004, docetaxel was the first chemotherapeutic agent to improve survival in crpc, but little else was available once patients recurred. Since 2010, four new options have been shown to improve survival in patients with refractory or recurring disease after docetaxel. In the management of bone metastases, two bone-targeted therapies have been shown to reduce the risk of bone complications, and they are part of the overall management strategy in crpc patients. Therapeutic options before chemotherapy have shown promising results and may soon become available in Canada. The present article reviews the treatment options that have shown to be effective in crpc and also some of the ongoing work in the field.
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14
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Zoubeidi A, Gleave M. Small heat shock proteins in cancer therapy and prognosis. Int J Biochem Cell Biol 2012; 44:1646-56. [DOI: 10.1016/j.biocel.2012.04.010] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 02/27/2012] [Accepted: 04/11/2012] [Indexed: 01/05/2023]
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Caffo O, Pappagallo G, Brugnara S, Caldara A, di Pasquale MC, Ferro A, Frisinghelli M, Murgia V, Russo LM, Soini B, Valduga F, Veccia A, Galligioni E. Multiple rechallenges for castration-resistant prostate cancer patients responding to first-line docetaxel: assessment of clinical outcomes and predictive factors. Urology 2012; 79:644-9. [PMID: 22386418 DOI: 10.1016/j.urology.2011.11.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 11/25/2011] [Accepted: 11/29/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the feasibility and efficacy of multiple sequential rechallenges and analyze the predictive factors that may aid in selecting patients who are more likely to respond. Several studies have demonstrated the feasibility and activity of a single docetaxel rechallenge in patients with castration-resistant prostate cancer (CRPC), thus providing an additional opportunity for treatment in docetaxel-sensitive CRPC patients in clinical practice. MATERIALS AND METHODS CRPC patients who completed first-line docetaxel therapy without disease progression have been offered a docetaxel rechallenge, and the responders have undergone further rechallenges until the appearance of docetaxel resistance. We assessed their clinical outcomes and evaluated all the variables potentially capable of predicting the response to rechallenge by means of uni- and multivariate analysis. RESULTS Forty-six consecutive patients underwent 92 rechallenges. The overall biochemical response rate (prostate-specific antigen [PSA] reduction >50%) was 66%. Median overall survival was 32 months with a projected 2-year overall survival from the first docetaxel administration of 77.5%. Multivariate analysis showed that the time slope-log PSA, the time from the previous cycle, and the response to the previous cycle were predictive of the response to a rechallenge. CONCLUSION A docetaxel rechallenge may be safely repeated several times in CRPC patients and in selected patients could improve disease control. The predictive factors found in our analysis may help select the most appropriate strategy in the light of the availability of active second-line drugs.
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Affiliation(s)
- Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy.
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Abstract
If androgen deprivation, chemical with LH-RH analogs or surgical with bilateral orchiectomy, still remains the stone edge of treatment of prostate cancer, in the metastatic setting, this hormonosensitivity, most of the time long, finally move on in hormonal-failure. If rare changes in the therapeutic strategy have been achieved in this setting since 2004 and the arrival of docetaxel, it is the global perception of the disease that has been modified and the definition of one specific entity: the castrate-resistant prostate cancer. This new definition and the changes of design and end-points of clinical trials testing new agents with strong recruitment during the past years have conducted to a real revolution in the management of castrate-refractory prostate cancer. The place of secondary hormonal manipulations, such as withdrawal of the anti-androgen, oestrogen or ketoconazole, still exists for a selected group of patients. In case of aggressive disease and symptoms, chemotherapy should be selected, docetaxel, in a three weeks schedule, and may be combined with Estracyt. It is time to consider the revolution of the post-chemotherapy setting with the arrival of two new drugs ; a cytotoxic one, the cabazitaxel and hormonal for the second one, the abiraterone acetate. The place of the immunotherapy with the sipuleucel-T may be more difficult to precise, especially in Europe, even if it has been finally indicated in the United States in the metastatic setting. Concerning bone metastasis, zoledronic acid was during a long time the only bone-targeted agent, effective in reducing the incidence of skeletal related events, and was recently exceeded by the denosumab, an anti-RANK ligand. Finally, let us hope that other changes will be achieved in the near future, with the cabazitaxel-docetaxel confrontation in the first-line setting, and the introduction of the abiraterone acetate before chemotherapy with docetaxel, already tested in ongoing trials.
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Kao SCH, Hovey E, Marx G. Second-line therapy for castrate-resistant prostate cancer: a literature review. Asia Pac J Clin Oncol 2012; 7:212-23. [PMID: 21884433 DOI: 10.1111/j.1743-7563.2011.01421.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite a survival benefit in the first-line treatment of castrate-resistant prostate cancer (CRPC) with docetaxel, the prognosis remains limited. There are increasing options available for patients with CRPC in the second-line setting, but there is currently little consensus regarding the optimal treatment. There have been numerous phase II and retrospective studies examining second-line options in CRPC, including retreatment with docetaxel, mitoxantrone, cyclophosphamide and carboplatin, which can be associated with meaningful responses in a significant minority of patients. In 2010 three randomized trials were published or presented which demonstrated a survival benefit in the second-line setting. These included cabazitaxel compared with mitoxantrone, sipuleucel-T (immunotherapy) and abiraterone acetate versus placebo. Ongoing research in the second-line setting of CRPC to optimize treatment options, with the objectives of survival prolongation, improvement in quality of life and pain management, is still needed.
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Affiliation(s)
- S C-H Kao
- Department of Medical Oncology, Concord Repatriation General Hospital, Sydney, NSW, Australia
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18
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New and emerging agents for the treatment of castration-resistant prostate cancer. Urol Oncol 2012; 29:S1-8. [PMID: 22074657 DOI: 10.1016/j.urolonc.2011.08.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 08/24/2011] [Accepted: 08/24/2011] [Indexed: 11/20/2022]
Abstract
Most men with recurrent prostate cancer (CaP) initially respond to androgen deprivation therapy but eventually develop metastatic castration-resistant prostate cancer (CRPC). Over the last decade, new therapeutic targets have been identified in CRPC and several new drugs have reached advanced stages of clinical development. In 2010, the Food and Drug Administration (FDA) approved sipuleucel-T and cabazitaxel, and in 2011, abiraterone for patients with metastatic CRPC based on phase 3 trials showing improved survival. Although not yet available for clinical use, a press release in June 2011 announced that radium 223 also demonstrated a survival advantage in men with metastatic CRPC. Emerging therapies in advanced stages of clinical development in CRPC include the hormonal therapies MDV3100 and TAK 700, and the immunotherapy ipilimumab. Results are also pending on phase 3 studies comparing docetaxel plus prednisone with docetaxel given with the novel agents aflibercept, dasatinib, lenalidomide, and custirsen. In addition to these new and emerging therapeutic agents, denosumab was approved for the prevention of skeletal complications in patients with bone metastases due to solid tumor malignancies, providing an alternative to zoledronic acid. While the addition of these new treatment options is a great advance for men with metastatic CRPC, there are many new questions arising regarding sequencing of these treatments with each other, with previously existing therapies, and with the emerging agents now in clinical trials. Furthermore, there are concerns that on-going phase 3 trials may be contaminated if patients go off study treatment to start 1 of the newly approved agents or take the agent subsequently. These realities make clinical trial design more challenging than ever.
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Gebbia V, Serretta V, Borsellino N, Valerio MR. Salvage Therapy With Oral Metronomic Cyclophosphamide and Methotrexate for Castration-refractory Metastatic Adenocarcinoma of the Prostate Resistant to Docetaxel. Urology 2011; 78:1125-30. [DOI: 10.1016/j.urology.2011.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 08/02/2011] [Accepted: 08/04/2011] [Indexed: 10/15/2022]
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Caffo O, Fratino L, Barbieri R, Perin A, Martini T, Sava T, Segati R, Vaccher E, Bernardo Bassan F, Veccia A, Pappagallo G, Galligioni E. Pemetrexed as second-line chemotherapy for castration-resistant prostate cancer after docetaxel failure: results from a phase II study. Urol Oncol 2011; 31:180-6. [PMID: 21803618 DOI: 10.1016/j.urolonc.2010.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/21/2010] [Accepted: 11/22/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although there is no standard treatment after docetaxel failure in patients with castration-resistant prostate cancer (CRPC), second-line chemotherapy is increasingly required. Its mechanism of action and toxicity profile make pemetrexed suitable for testing in this setting. METHODS AND MATERIALS Patients with docetaxel-resistant CRPC received pemetrexed 500 mg/m(2) every 3 weeks for 6 courses. The usual premedication with vitamin supplementation and dexamethasone prophylaxis was regularly administered. The primary objective was to quantify the biochemical response rate. RESULTS The biochemical response rate was 10.5% (95% CI 1.3-33.1), with 2 patients showing a reduction in prostate specific antigen (PSA) of ≥50%. The null hypothesis that the PSA response rate would be less than 20% was therefore accepted, and patient accrual was stopped after the evaluation of the 19th patient. The 1-year overall survival rate was 61.5%, with a median survival of 14 months. A considerable proportion of the patients (36%) were withdrawn from the study because of hematologic and nonhematologic toxicity. CONCLUSIONS Our experience with pemetrexed in CRPC patients appears discouraging in terms of activity and toxicity. No further studies of this drug should be performed in CRPC patients.
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Affiliation(s)
- Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy.
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Saad F, Hotte S, North S, Eigl B, Chi K, Czaykowski P, Wood L, Pollak M, Berry S, Lattouf JB, Mukherjee SD, Gleave M, Winquist E. Randomized phase II trial of Custirsen (OGX-011) in combination with docetaxel or mitoxantrone as second-line therapy in patients with metastatic castrate-resistant prostate cancer progressing after first-line docetaxel: CUOG trial P-06c. Clin Cancer Res 2011; 17:5765-73. [PMID: 21788353 DOI: 10.1158/1078-0432.ccr-11-0859] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE Clusterin (CLU) is an antiapoptotic, stress-induced protein conferring treatment resistance when overexpressed. This study tested custirsen, a CLU inhibitor, in patients with metastatic castration-resistant prostate cancer (mCRPC) progressing during or within 6 months of initial docetaxel therapy. PATIENTS AND METHODS Men were randomized to receive either docetaxel + prednisone + custirsen (DPC) or mitoxantrone + prednisone + custirsen (MPC). RESULTS Forty-two patients received study treatment. Toxicity was similar in both arms. Twenty patients treated with DPC received a median of 8 cycles; overall survival (OS) was 15.8 months. Median time to pain progression (TTPP) was 10.0 months; 10 of 13 (77%) evaluable patients had pain responses. Three of 13 (23%) evaluable patients had objective partial responses. Prostate-specific antigen (PSA) declines of 90% or more, 50% or more, and 30% or more occurred in 4 (20%), 8 (40%), and 11 (55%) patients, respectively. Twenty-two patients treated with MPC received a median of 6 cycles; OS was 11.5 months. The median TTPP was 5.2 months; 6 of 13 (46%) evaluable patients had pain responses. No objective responses were observed. PSA declines of 50% or more and 30% or more occurred in 6 (27%) and 7 (32%) patients, respectively. Low serum CLU levels during treatment showed superior survival for patients based on modeling with proportional hazard regression with a time-dependent covariate and different landmarks. CONCLUSIONS Custirsen plus either docetaxel or mitoxantrone was feasible in patients with progressive mCRPC following first-line docetaxel therapy. Pain relief was higher than expected, with interesting correlations between serum CLU and survival. A phase III trial evaluating the pain palliation benefit of custirsen with taxane therapy is ongoing.
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Affiliation(s)
- Fred Saad
- CRCUM-Université de Montréal, Hamilton, Ontario, Canada.
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22
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Hotte SJ, Saad F. Current management of castrate-resistant prostate cancer. ACTA ACUST UNITED AC 2011; 17 Suppl 2:S72-9. [PMID: 20882137 DOI: 10.3747/co.v17i0.718] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prostate cancer (PCa) is the most frequently diagnosed cancer in North America. Castrate-resistant PCa presents a spectrum of disease ranging from rising PSA levels in the absence of metastases or symptoms and despite androgen-deprivation therapy, to metastases and significant debilitation from cancer symptoms. Castrate-resistant PCa is usually suspected in patients with new symptoms on androgen deprivation therapy, with a rising PSA, or with new evidence of disease on bone scans or computed tomography scans. Institution of treatment and the choice of systemic or local therapy depend on a number of factors. This review discusses the various currently available treatments for patients with castrate-resistant PCa, from secondary hormonal manipulations to options for post-docetaxel systemic therapy.
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Affiliation(s)
- S J Hotte
- Department of Oncology, McMaster University, and Juravinski Cancer Centre, Hamilton, ON.
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23
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Harrington JA, Jones RJ. Management of metastatic castration-resistant prostate cancer after first-line docetaxel. Eur J Cancer 2011; 47:2133-42. [PMID: 21658937 DOI: 10.1016/j.ejca.2011.04.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/15/2011] [Accepted: 04/27/2011] [Indexed: 11/28/2022]
Abstract
Although chemotherapy, based on docetaxel, is now established in the management of metastatic castration-resistant prostate cancer (mCRPC), until recently, there has been no treatment licensed for use in the second line in men whose disease progresses during or after docetaxel therapy. This article reviews the classes of agents that have shown potential in this setting, notably chemotherapy drugs, hormonal therapies, immunotherapies, anti-angiogenic drugs, and clusterin-targeted therapy.
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Affiliation(s)
- J A Harrington
- Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge, England, UK
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24
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Phase II trial of cisplatin plus prednisone in docetaxel-refractory castration-resistant prostate cancer patients. Cancer Chemother Pharmacol 2011; 67:1455-61. [DOI: 10.1007/s00280-011-1594-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Accepted: 01/27/2011] [Indexed: 11/27/2022]
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Kim SJ, Kim SI. Current treatment strategies for castration-resistant prostate cancer. Korean J Urol 2011; 52:157-65. [PMID: 21461278 PMCID: PMC3065126 DOI: 10.4111/kju.2011.52.3.157] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/21/2011] [Indexed: 11/25/2022] Open
Abstract
Prostate cancer is the most common cancer in men in United States and the fifth most common cancer in men in Korea. Although the majority of patients with metastatic prostate cancer initially respond to androgen deprivation therapy, almost all patients will eventually progress to develop castration-resistant prostate cancer (CRPC). Treatment options for CRPC remain limited. Prostate cancer was considered unresponsive to chemotherapy until the mid-1990s, when mitoxantrone combined with prednisone was shown to play a role in the palliative treatment of patients with CRPC. In 2004, two large randomized clinical trials demonstrated for the first time a small but significant survival advantage of docetaxel-based chemotherapy compared with mitoxantrone in patients with metastatic CRPC. Recently, cabazitaxel was shown to improve survival in patients with metastatic CRPC who progressed after docetaxel-based chemotherapy. Sipuleucel-T was also demonstrated to improve overall survival in patients with asymptomatic or minimally symptomatic metastatic CRPC. Along with mitoxantrone and docetaxel, cabazitaxel and sipuleucel-T are now approved for use in metastatic CRPC by the US Food and Drug Administration. There have been multiple early-phase clinical trials of various agents for the treatment of CRPC, and some are in phase III development. This review focuses on the key clinical trials of various treatment options of CRPC currently in use and under investigation.
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Affiliation(s)
- Se Joong Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
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26
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Colloca G, Venturino A, Checcaglini F. Second-line chemotherapy in metastatic docetaxel-resistant prostate cancer: a review. Med Oncol 2011; 29:776-85. [PMID: 21336988 DOI: 10.1007/s12032-011-9855-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
Abstract
The results of cytotoxic therapy in the second-line setting of metastatic castration-resistant prostate cancer have demonstrated that disease is poorly controlled after taxane resistance with a time to progression of 3 months or less. Many trials of second-line chemotherapy have been disappointing. However, most of patients with docetaxel-pretreated castration-resistant disease receive a second-line chemotherapy. Molecular mechanism of castration resistance and docetaxel resistance is resumed, and clinical trials of second-line chemotherapy after docetaxel progression are reviewed. Reintroduction of docetaxel after a drug-free interval is an active treatment in docetaxel-pretreated patients, and only recently a prospective study documented a survival benefit of 2.4 months after second-line taxane-based chemotherapy of metastatic docetaxel-resistant prostate cancer. Although a second-line chemotherapy with a taxane could improve overall survival, a change of biology of castration-resistant prostate cancer after docetaxel is suggested, as inferred by the renewed hormonal sensitivity, whose role on survival remains unknown, and from the activity of antiangiogenic drugs.
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Affiliation(s)
- Giuseppe Colloca
- Division of Medical Oncology, "Giovanni Borea" Hospital, Via Giovanni Borea n. 56, 18038 Sanremo, Imperia, Italy.
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Koupparis A, Casey R, Robinson M, Gleave ME. Novel targeted agents on the horizon for castration-resistant prostate cancer. Future Oncol 2010; 6:1883-95. [DOI: 10.2217/fon.10.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Androgen deprivation treatment in prostate cancer patients is well established; however, resistance to such treatment manifests itself by progression to castration-resistant prostate cancer (CRPC). Despite significant advances in treatment options for patients with CRPC, their prognosis remains poor. Resistance results from multiple processes that facilitate cancer cell growth and survival. Mechanisms underlying the shift to castrate resistance have been attributed to a complex interplay of clonal selection, reactivation of the androgen receptor axis despite castrate levels of serum testosterone, stress-induced prosurvival genes and cytoprotective chaperone networks and alternative mitogenic growth factor pathways. This article discusses several pathways involved in the development of CRPC, with a particular focus on those mechanisms that have led to the development of new targeted therapies.
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Affiliation(s)
- Anthony Koupparis
- The Vancouver Prostate Centre & Department of Urological Sciences, 2775 Laurel St., Vancouver, BC V6H 3Z6, Canada
| | - Rowan Casey
- The Vancouver Prostate Centre & Department of Urological Sciences, 2775 Laurel St., Vancouver, BC V6H 3Z6, Canada
| | - Michael Robinson
- The Vancouver Prostate Centre & Department of Urological Sciences, 2775 Laurel St., Vancouver, BC V6H 3Z6, Canada
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Saad F, Hotte SJ. Guidelines for the management of castrate-resistant prostate cancer. Can Urol Assoc J 2010; 4:380-4. [PMID: 21191494 PMCID: PMC2997826 DOI: 10.5489/cuaj.10167] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Fred Saad
- Correspondence: Dr. Fred Saad, Université de Montréal, Directeur, Urologie-Oncologie, CHUM, 1560 Sherbrooke E., Montréal, QC H2L 4M1;
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A phase II study of 2-methoxyestradiol (2ME2) NanoCrystal® dispersion (NCD) in patients with taxane-refractory, metastatic castrate-resistant prostate cancer (CRPC). Invest New Drugs 2010; 29:1465-74. [PMID: 20499131 DOI: 10.1007/s10637-010-9455-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE 2ME2 (Panzem®) is a non-estrogenic derivative of estradiol with antiproliferative and antiangiogenic activity. Preclinical data support antitumor activity in prostate cancer. This trial evaluated the efficacy of 2ME2 NCD in patients with taxane-refractory, metastatic CRPC. EXPERIMENTAL DESIGN Patients with metastatic CRPC who had progressed on only one prior taxane-based regimen were eligible. All patients received 2ME2 NCD at 1,500 mg orally four times daily, repeated in 28 day cycles. The primary endpoint was progression-free survival at month 6, with a secondary endpoint of PSA response. An exploratory endpoint was metabolic response on FDG-PET imaging. RESULTS A total of 50 pts was planned. The study was terminated after 21 pts when a futility analysis showed the primary endpoint was unlikely to be reached. The median number of cycles on study was 2 (range <1 to 12). Adverse events (AE) of grade ≥3 related to the study drug occurred in 7 unique patients (33%): elevations in liver function tests, fatigue or weakness, gastrointestinal hemorrhage, and hyponatremia. Paired FDG-PET scans were obtained for 11 pts. No metabolic responses were observed. CONCLUSIONS 2ME2 NCD did not appear to have clinically significant activity in this study. 2ME2 NCD was well-tolerated and showed some evidence of biologic activity. Given the aggressive biology in this taxane-refractory population, the potential benefit from a cytostatic agent like 2ME2 might better be realized in the pre-chemotherapy (or rising PSA only) stage of CRPC.
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Garzotto M, Higano CS, O'Brien C, Rademacher BLS, Janeba N, Fazli L, Lange PH, Lieberman S, Beer TM. Phase 1/2 study of preoperative docetaxel and mitoxantrone for high-risk prostate cancer. Cancer 2010; 116:1699-708. [PMID: 20143429 DOI: 10.1002/cncr.24960] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND : A study was conducted to determine the 5-year recurrence-free survival in patients with high-risk prostate cancer after neoadjuvant combination chemotherapy followed by surgery. Secondary endpoints included safety, pathologic effects of chemotherapy, and predictors of disease recurrence. METHODS : Fifty-seven patients were enrolled in a phase 1/2 study of weekly docetaxel 35 mg/m(2) and escalating mitoxantrone to 4 mg/m(2) before prostatectomy. Patients were treated with 16 weeks of chemotherapy administered weekly on a 3 of every 4 week schedule. A tissue microarray, constructed from the prostatectomy specimens, served to facilitate the exploratory evaluation of biomarkers. The primary endpoint was recurrence-free survival. Disease recurrence was defined as a confirmed serum prostate-specific antigen (PSA) >0.4 ng/mL. RESULTS : Of the 57 patients, 54 received 4 cycles of docetaxel and mitoxantrone before radical prostatectomy. Grade 4 toxicities were limited to leukopenia, neutropenia, and hyperglycemia. Serum testosterone levels remained stable after chemotherapy. Negative surgical margins were attained in 67% of cases. Lymph node involvement was detected in 18.5% of cases. With a median follow-up of 63 months, 27 of 57 (47.4%) patients recurred. The Kaplan-Meier recurrence-free survival at 2 years was 65.5% (95% confidence interval [CI], 53.0%-78.0%) and was 49.8% at 5 years (95% CI, 35.5%-64.1%). Pretreatment serum PSA, lymph node involvement, and postchemotherapy tissue vascular endothelial growth factor expression were independent predictors of early recurrence. CONCLUSIONS : Preoperative chemotherapy with docetaxel and mitoxantrone is feasible. Approximately half of the high-risk patients remain free of disease recurrence at 5 years, and clinical and molecular predictors of early recurrence were identified. Cancer 2010. (c) 2010 American Cancer Society.
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Affiliation(s)
- Mark Garzotto
- Division of Urology, Oregon Health and Science University, Portland Veterans Administration Medical Center, Portland, Oregon, USA
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31
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Goktas S, Baran Y, Ural AU, Yazici S, Aydur E, Basal S, Avcu F, Pekel A, Dirican B, Beyzadeoglu M. Proteasome Inhibitor Bortezomib Increases Radiation Sensitivity in Androgen Independent Human Prostate Cancer Cells. Urology 2010; 75:793-8. [DOI: 10.1016/j.urology.2009.07.1215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 06/26/2009] [Accepted: 06/02/2009] [Indexed: 10/20/2022]
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Reuter CWM, Morgan MA, Ivanyi P, Fenner M, Ganser A, Grünwald V. Carboplatin plus weekly docetaxel as salvage chemotherapy in docetaxel-resistant and castration-resistant prostate cancer. World J Urol 2010; 28:391-8. [PMID: 20229232 DOI: 10.1007/s00345-010-0527-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 02/23/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is no proven, effective, standard second-line chemotherapy for castration- and docetaxel-resistant prostate cancer (DRPC). Recent data suggest that carboplatin may be effective in combination with docetaxel in this setting; however, the optimal docetaxel/carboplatin-based regimen is still unclear. AIM OF THE STUDY We identified 43 consecutive patients with DRPC treated with carboplatin (AUC5 d1) and docetaxel (35 mg/m(2) d1, 8, 15 q4w i.v.) as a second-line or subsequent salvage chemotherapy until discontinuation of therapy due to disease progression or unacceptable toxicity. RESULTS Decreased prostate-specific antigen (> or =50% PSA) was observed in 22/43 (51.2%, 95% CI, 35.5, 66.7%) patients, with > or =90% reduction in 12/43 patients (27.9%). At the time of analysis, the median follow-up time for all patients was 10.4 months. Median progression-free survival (PFS) for all patients was 6.5 months (95% CI 4.1, 8.9), and median overall survival (OS) was 15.8 months (95% CI 12.1, 18.5). In PSA responders, PFS was 9.5 (95% CI 8.2, 19.0) months versus 3.3 (95% CI 2.6, 4.0) months in PSA non-responders (P < 0.0001; hazard ratio (HR) 0.108) and OS was 24.4 months (95% CI 19.5, 29.4) versus 7.8 (95% CI 5.2, 10.3) months (P = 0.001; HR 0.232). Established prognostic factors were associated with survival. This regimen was reasonably well tolerated, with leukopenia/neutropenia as the most common reversible grade 3/4 toxicity (41.9/39.5%). CONCLUSION These data suggest that weekly docetaxel plus carboplatin may be an important therapeutic second-line treatment option for patients with DRPC.
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Affiliation(s)
- Christoph W M Reuter
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Eymard JC, Oudard S, Gravis G, Ferrero JM, Theodore C, Joly F, Priou F, Krakowski I, Zannetti A, Thill L, Beuzeboc P. Docetaxel reintroduction in patients with metastatic castration-resistant docetaxel-sensitive prostate cancer: a retrospective multicentre study. BJU Int 2010; 106:974-8. [PMID: 20230389 DOI: 10.1111/j.1464-410x.2010.09296.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the potential benefit of reintroducing docetaxel chemotherapy in patients with progressive metastatic castration-resistant prostate cancer (mCRPC) who had initially responded to first-line docetaxel-based regimen. PATIENTS AND METHODS Records were evaluated retrospectively from French patients with mCRPC who had been included in seven controlled clinical studies of docetaxel as first-line treatment. We identified patients who were confirmed as responders to first-line treatment, discontinued for reasons other than disease progression or unacceptable toxicity, and who received further docetaxel chemotherapy for disease progression. The primary objective was to assess efficacy in terms of the prostate-specific antigen (PSA) response after resuming a docetaxel-based chemotherapy. Secondary objectives were overall survival and tolerance. RESULTS Of the 148 patients who responded to first-line docetaxel, 50 received further therapy with docetaxel and were analysed. The median (range) response duration to first-line docetaxel was 10.3 (4.6-45.7) months and the median docetaxel-free interval was 18.4 (5.0-46.7) months. Docetaxel was reintroduced as second-line therapy in 52% of patients and as further lines in 48%. After docetaxel reintroduction, 24 patients (48%) had a 50% decrease in PSA level (95% confidence interval, CI, 34.1-61.8%). The median (95% CI) overall survival from docetaxel reintroduction was 16 (13-20) months. Re-treatment was well tolerated (6% of grade 3-4 haemotoxicity). CONCLUSION Docetaxel reintroduction appears to be effective, with favourable tolerance profiles, in patients with mCRPC having responded to first-line docetaxel, and should be prospectively assessed in clinical trials against alternative therapies or investigational agents given alone or in combination, to define further management.
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Zoubeidi A, Chi K, Gleave M. Targeting the cytoprotective chaperone, clusterin, for treatment of advanced cancer. Clin Cancer Res 2010; 16:1088-93. [PMID: 20145158 PMCID: PMC2822877 DOI: 10.1158/1078-0432.ccr-09-2917] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many strategies used to kill cancer cells induce stress-responses that activate survival pathways to promote emergence of a treatment resistant phenotype. Secretory clusterin (sCLU) is a stress-activated cytoprotective chaperone up-regulated by many varied anticancer therapies to confer treatment resistance when overexpressed. sCLU levels are increased in several treatment recurrent cancers including castrate resistant prostate cancer, and therefore sCLU has become an attractive target in cancer therapy. sCLU is not druggable with small molecule inhibitors, therefore nucleotide-based strategies to inhibit sCLU at the RNA level are appealing. Preclinical studies have shown that antisense oligonucleotide (ASO) or siRNA knockdown of sCLU have preclinical activity in combination with hormone- and chemotherapy. Phase I and II clinical trial data indicate that the second generation ASO, custirsen (OGX-011), has biologic and clinical activity, suppressing sCLU expression in prostate cancer tissues by more than 90%. A randomized study comparing docetaxel-custirsen to docetaxel alone in men with castrate resistant prostate cancer reported improved survival by 7 months from 16.9 to 23.8 months. Strong preclinical and clinical proof-of-principle data provide rationale for further study of sCLU inhibitors in randomized phase III trials, which are planned to begin in 2010.
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Affiliation(s)
- Amina Zoubeidi
- Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
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Abstract
Prostate cancer mortality usually occurs as a result of castrate resistant disease. Many approaches are currently being evaluated to improve the treatment of this condition. These include drugs that induce androgen deprivation, that is, LHRH antagonists; more active or less toxic chemotherapy agents; immunologic approaches, including passive and active immunization; drugs that target the androgen receptor and/or androgen synthesis; drugs that target specific pathways, including tyrosine kinase inhibitors, angiogenesis inhibitors, endothelin antagonists and matrix metalloproteinase inhibitors; and antioxidants and cell cycle inhibitors. Many of these agents seem promising. The rationale, biologic activity and therapeutic results of these emerging drugs are reviewed.
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Affiliation(s)
- Kashif Siddiqui
- University of Toronto, Sunnybrook Health Sciences Centre, Division of Urology, 2075 Bayview Ave. #MG408 Toronto, Ontario M4N 3M5, Canada
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Fontana A, Galli L, Fioravanti A, Orlandi P, Galli C, Landi L, Bursi S, Allegrini G, Fontana E, Di Marsico R, Antonuzzo A, D'Arcangelo M, Danesi R, Del Tacca M, Falcone A, Bocci G. Clinical and Pharmacodynamic Evaluation of Metronomic Cyclophosphamide, Celecoxib, and Dexamethasone in Advanced Hormone-refractory Prostate Cancer. Clin Cancer Res 2009; 15:4954-62. [DOI: 10.1158/1078-0432.ccr-08-3317] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hahn NM, Zon RT, Yu M, Ademuyiwa FO, Jones T, Dugan W, Whalen C, Shanmugam R, Skaar T, Sweeney CJ. A phase II study of pemetrexed as second-line chemotherapy for the treatment of metastatic castrate-resistant prostate cancer (CRPC); Hoosier Oncology Group GU03-67. Ann Oncol 2009; 20:1971-6. [PMID: 19605506 DOI: 10.1093/annonc/mdp244] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND No standard therapy exists for post-docetaxel castrate-resistant prostate cancer (CRPC) patients. This trial aimed to determine the safety and efficacy of pemetrexed in post-docetaxel CRPC patients. MATERIALS AND METHODS CRPC patients with progression after docetaxel (Taxotere) therapy received pemetrexed (500 mg/m2) i.v. every 3 weeks. The primary end point was prostate-specific antigen (PSA) response. A pharmacogenetic analysis of the reduced folate carrier-1 gene (RFC1) G80A polymorphism was also carried out. RESULTS Forty-nine patients were enrolled: median age 68 years, median baseline PSA 72 ng/ml, and median Karnofsky performance status of 90. Grade 3 or 4 toxicity occurred in 20 (43%) and four patients (8%), respectively. Confirmed >50% PSA decline occurred in four patients (8%), stable PSA lasting at least 12 weeks in 10 patients (20%). A significant relationship was observed between time from prior docetaxel therapy and overall survival. Pharmacogenetic analyses of RFC1 G80A genotype frequencies showed no relationship between genotypes and clinical efficacy. CONCLUSIONS Pemetrexed treatment of CRPC patients after docetaxel therapy was associated with only modest clinical activity. Further investigation of pemetrexed as a single agent in a nonenriched CRPC population is unlikely to add significant clinical benefit over that seen with traditional second-line chemotherapy agents such as mitoxantrone.
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Affiliation(s)
- N M Hahn
- Department of Medicine, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
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Thomas C, Hadaschik B, Thüroff J, Wiesner C. Docetaxel-refraktäre Patienten mit metastasiertem hormonrefraktären Prostatakarzinom. Urologe A 2009; 48:1070-4. [DOI: 10.1007/s00120-009-2006-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wen X, Li X, Liao B, Liu Y, Wu J, Yuan X, Ouyang B, Sun Q, Gao X. Knockdown of p21-activated kinase 6 inhibits prostate cancer growth and enhances chemosensitivity to docetaxel. Urology 2009; 73:1407-11. [PMID: 19362342 DOI: 10.1016/j.urology.2008.09.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 09/11/2008] [Accepted: 09/18/2008] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate whether silencing of p21-activated kinase 6 (PAK6) would inhibit prostate cancer growth and to assess the effect of PAK6 silencing when used in combination with docetaxel. PAK6 is a serine/threonine kinase belonging to the PAK family and has been implicated in cell motility, apoptosis, and transformation. METHODS Expression of PAK6 in PC-3, DU145, and LAPC4 prostate cancer cell lines was knocked down by small, interfering RNA (siRNA). Cellular proliferation, cell cycle distribution, the ability to undergo apoptosis, and the invasive capacity through matrigel were evaluated. Furthermore, in vivo growth of prostate cancer in nude mice treated with PAK6-siRNA alone or in combination with docetaxel was examined. RESULTS PAK6 was overexpressed in prostate cancer tissues. PAK6-siRNA efficiently and specifically downregulated the expression of PAK6 and inhibited cell growth of prostate cancer. It also suppressed invasive ability in matrigel and caused cell cycle arrest at the G(2)/M phase. Xenograft tumor growth in nude mice was inhibited significantly by PAK6-siRNA. The average weight of the harvested tumor was 46 +/- 8.5 mg in the PAK6-siRNA group, lower than the 451 +/- 22.3 mg in the control group (P < .05). Combined use of PAK6-siRNA and docetaxel produced a greater effect than docetaxel alone in both in vitro and in vivo models. CONCLUSIONS Knockdown of PAK6 expression produced an inhibitory effect on prostate cancer growth and enhanced chemosensitivity of docetaxel. PAK6 could be a valuable molecular target for the treatment of prostate cancer.
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Affiliation(s)
- Xingqiao Wen
- Department of Urology, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Loriot Y, Massard C, Gross-Goupil M, Di Palma M, Escudier B, Bossi A, Fizazi K. Combining carboplatin and etoposide in docetaxel-pretreated patients with castration-resistant prostate cancer: a prospective study evaluating also neuroendocrine features. Ann Oncol 2009; 20:703-8. [DOI: 10.1093/annonc/mdn694] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chi KN, Zoubeidi A, Gleave ME. Custirsen (OGX-011): a second-generation antisense inhibitor of clusterin for the treatment of cancer. Expert Opin Investig Drugs 2009; 17:1955-62. [PMID: 19012510 DOI: 10.1517/13543780802528609] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clusterin is a stress-induced cytoprotective chaperone protein, regulated by HSF1, and functions similarly to a small heat-shock protein. Clusterin is expressed in a variety of cancers and associated with broad-spectrum treatment resistance. Custirsen (OGX-011) is a 2'-methoxyethyl modified phosphorothioate antisense oligonucleotide that is complementary to clusterin mRNA; it is currently in clinical trials for patients with cancer. OBJECTIVE/METHODS To review the literature on the role of clusterin in cancer progression and treatment resistance, and to summarize completed and ongoing clinical trials with custirsen. RESULTS/CONCLUSIONS Custirsen is well tolerated in humans and biologically active in inhibiting expression of clusterin in patients with cancer. Randomized trials of custirsen in combination with chemotherapy are planned in patients with castration-resistant prostate cancer.
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Affiliation(s)
- Kim N Chi
- The Prostate Centre at Vancouver General Hospital, 6th Floor, 2775 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada
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Rosenberg JE, Oh WK. What is the current status of second-line chemotherapy for castration-resistant prostate cancer? NATURE CLINICAL PRACTICE. UROLOGY 2008; 5:650-651. [PMID: 18936787 DOI: 10.1038/ncpuro1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 09/18/2008] [Indexed: 05/26/2023]
Affiliation(s)
- Jonathan E Rosenberg
- Harvard Medical School, Lank Center for Genitourinary Oncology, Dana-Farber CancerInstitute, Boston, MA 02446, USA.
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Joung JY, Jeong IG, Han KS, Kim TS, Yang SO, Seo HK, Chung J, Cho KS, Lee KH. Docetaxel chemotherapy of Korean patients with hormone- refractory prostate cancer:comparative analysis between 1st-line and 2nd-line docetaxel. Yonsei Med J 2008; 49:775-82. [PMID: 18972598 PMCID: PMC2615369 DOI: 10.3349/ymj.2008.49.5.775] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE This study was undertaken to investigate the outcomes associated with docetaxel treatment of Korean patients with hormone-refractory prostate cancer (HRPC) and to compare its clinical efficacies in 1st and 2nd-line settings. PATIENTS AND METHODS This study was retrospectively performed and included 47 patients with HRPC. The 1st-line group consisted of 19 patients who had not undergone prior chemotherapy, and the 2nd-line group consisted of 28 patients who underwent prior chemotherapy. All patients were treated with 75mg/m2 IV docetaxel every 3 weeks and 5mg of prednisone twice daily with a continuous androgen blockade. RESULTS Of 47 study subjects, 14 patients (29.8%) had > or = 50% PSA decline from baseline. PSA response was more common in the 1st-line group, but this was not statistically different (42.1% vs. 21.4%, p = 0.114). After a median follow up of 11 months (range, 6-24 months), the 1st-line group showed a longer time to PSA progression (4 vs. 2 months, p = 0.015) and survival (17 vs. 10 months, p = 0.037) than the 2nd-line group. In terms of toxicities, no difference was apparent between the 2 groups. CONCLUSION In a 1st-line setting, docetaxel is an effective and tolerable agent for Korean HRPC patients, and that its efficacy is limited, although 2nd-line docetaxel is tolerable.
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Affiliation(s)
- Jae Young Joung
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - In Gab Jeong
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Kyung Seok Han
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Taek Sang Kim
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Seung Ok Yang
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Ho Kyung Seo
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Jinsoo Chung
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Kang Su Cho
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Kang Hyun Lee
- Urologic Oncology Clinic, National Cancer Center, Goyang, Korea
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Systemic therapy after first-line docetaxel in metastatic castration-resistant prostate cancer. Curr Opin Support Palliat Care 2008; 2:161-6. [PMID: 18685415 DOI: 10.1097/spc.0b013e32830c48a3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is an urgent need for systemic treatment options for patients with castration-resistant prostate cancer who have progressed after receiving first-line docetaxel chemotherapy. The purpose of this article is to review recent developments in this area. RECENT FINDINGS Retreatment with docetaxel has been employed with evidence of activity in selected populations. Mitoxantrone, the previous first-line standard based on its palliative effect, has also been used with clinical responses observed; however, the symptom benefit in this setting has not been established. Several classes of cytotoxic agents have been tested including platinum agents (satraplatin), epothilones (ixabepilone and patupilone) and taxanes (XRP-6258). A number of targeted therapies have also been clinically evaluated including inhibitors of cytoprotective chaperones (OGX-011) and the vascular endothelial growth factor receptor (sorafenib, sunitinib, and cediranib). An area generating great interest has been the development of agents that target the androgen receptor axis more effectively (MDV3100 and abiraterone) with encouraging early phase trial results. SUMMARY There is no accepted standard systemic treatment for patients with castration resistant prostate cancer and progressive disease after docetaxel. Novel agents are in phase II and III clinical testing in this setting.
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Sonpavde G, Hutson TE, Berry WR, Boehm KA, Asmar L. Phase II Trial of Sunitinib for the Therapy of Progressive Metastatic Castration-Refractory Prostate Cancer After Previous Docetaxel Chemotherapy. Clin Genitourin Cancer 2008; 6:134-7. [DOI: 10.3816/cgc.2008.n.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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46
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Dreicer R. Current status of cytotoxic chemotherapy in patients with metastatic prostate cancer. Urol Oncol 2008; 26:426-9. [DOI: 10.1016/j.urolonc.2007.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Saad F, Ruether D, Ernst S, North S, Cheng T, Perrotte P, Karakiewicz P, Winquist E. The Canadian Uro-Oncology Group multicentre phase II study of docetaxel administered every 3 weeks with prednisone in men with metastatic hormone-refractory prostate cancer progressing after mitoxantrone/prednisone. BJU Int 2008; 102:551-5. [PMID: 18510661 DOI: 10.1111/j.1464-410x.2008.07733.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the use of docetaxel 75 mg/m(2) intravenously every 3 weeks plus prednisone 5 mg orally twice daily in men with metastatic hormone-refractory prostate cancer (HRPC) progressing after first-line mitoxantrone/prednisone (MP), the primary outcome being progression-free survival with prostatic-specific antigen (PSA) and pain response, toxicity and quality of life (QoL) also assessed. PATIENTS AND METHODS Thirty patients from four centres were enrolled in the study; all had had previous MP for symptomatic, metastatic HRPC and all had castrate levels of testosterone maintained during therapy. RESULTS At enrolment, the median age was 69 years, the mean PSA level was 324 ng/dL, and 86% of patients reported pain. There was a PSA response in 57% of the men and a reduction in pain in >60%; the overall QoL was maintained. There were four cases of febrile neutropenia and two treatment-related deaths. The median progression-free and overall survival were 5 and 15 months, respectively. CONCLUSION Docetaxel was associated with high rates of PSA and pain response in this study. Non-haematological toxicity was similar to that during first-line treatment, but rates of febrile neutropenia and toxic death appeared to be slightly higher. In selected patients with progressive metastatic HRPC previously treated with mitoxantrone, docetaxel appears to be a beneficial therapeutic option.
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Affiliation(s)
- Fred Saad
- University of Montreal Hospital Centre, Montreal, PQ, Canada.
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Berthold DR, Pond GR, de Wit R, Eisenberger M, Tannock IF. Survival and PSA response of patients in the TAX 327 study who crossed over to receive docetaxel after mitoxantrone or vice versa. Ann Oncol 2008; 19:1749-53. [PMID: 18487550 DOI: 10.1093/annonc/mdn288] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The TAX 327 study compared 3-weekly docetaxel, weekly docetaxel or 3-weekly mitoxantrone, each with prednisone, for 1006 patients with metastatic hormone-refractory prostate cancer. Survival and symptom control were superior following 3-weekly docetaxel as compared with mitoxantrone. At progression, many patients were treated with the other drug. Here, we provide a retrospective report of survival and prostate-specific antigen (PSA) response after second-line therapy. METHODS The TAX 327 database provided information about treatment after progression on first-line therapy, and survival has been updated. Investigators were asked to provide information about crossover treatment and serial PSA values. RESULTS We identified 232 crossover patients. Median survival after crossover was 10 months and did not depend on direction of crossover. Data on PSA response are available for 96 patients: PSA response (> or =50% reduction) occurred in 15% of 71 men receiving mitoxantrone after docetaxel and in 28% of 25 men receiving docetaxel after mitoxantrone. Median PSA progression-free survival was 3.4 months for mitoxantrone after docetaxel and 5.9 months for docetaxel after mitoxantrone. CONCLUSIONS One quarter of men received crossover therapy and survival was similar in the crossover groups. The PSA response rate to docetaxel after mitoxantrone was higher than that for mitoxantrone after docetaxel.
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Affiliation(s)
- D R Berthold
- Division of Medical Oncology and Hematology, Princess Margaret Hospital and University of Toronto, Toronto, Ontario, Canada
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Lainakis G, Nikos A, Gerassimos A, Michael C, Iraklis M, Konstantinos L, Ioannis V, Harilaos K, Dimopoulos MA, Bamias A. Biweekly doxorubicin/ketoconazole as second-line treatment in docetaxel-resistant, hormone-refractory prostate cancer. Urology 2008; 71:1181-5. [PMID: 18400264 DOI: 10.1016/j.urology.2008.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 02/19/2008] [Accepted: 02/21/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Docetaxel is an effective first-line treatment for hormone-refractory prostate cancer. Nevertheless, the prognosis subsequent to progression after first-line therapy is poor and no second-line treatment has been established. METHODS A total of 34 patients with androgen-independent prostate cancer received doxorubicin, 30 mg/m(2), every 2 weeks and ketoconazole daily, 400 mg orally every 8 hours. All patients had been treated with docetaxel and had disease progression within 6 months after completion of first-line treatment. RESULTS Of the 32 evaluable patients, 13 (43.7%, 95% confidence interval [CI] 26.3% to 62.3%) had a prostate-specific antigen (PSA) response, and 4 (28%, 95% CI 8.4% to 58.1%) of 14 patients with measurable disease had a response to therapy. The median time to progression (TTP) was 3.9 months (95% CI 2.0 to 5.9), and the median overall survival (OS) was 13 months (95% CI 8.7 to 17.3). Toxicity was mild, with only 4 cases of nonhematologic grade 3 or 4 toxicity. The most frequent toxicity was nail changes (33 of 34 patients), which was mainly grade 1 (30 cases). CONCLUSIONS The combination of biweekly doxorubicin and ketoconazole is an effective, well-tolerated, second-line therapy for hormone-refractory prostate cancer.
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Affiliation(s)
- George Lainakis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
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Le traitement des cancers de la prostate hormonorésistants. AFRICAN JOURNAL OF UROLOGY 2008. [DOI: 10.1007/bf02994512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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