[Metastasized prostate cancer. Position paper on the use of chemotherapy]

[Metastatic prostate cancer : Update: position paper for the use of chemotherapy]

BACKGROUND

Taxen-based chemotherapy has been established as an effective treatment option in castration-resistant metastatic prostate cancer (mCRPC). Randomized phase III studies, however, have shown that even in the hormone-naïve metastatic state, the early use of chemotherapy in addition to the classical androgen deprivation therapy (ADT) approach leads to a significant increase in median overall survival.

OBJECTIVE

This position paper aims to provide current data and orientation in the evidence-based treatment of mPC patients in daily clinical practice.

MATERIALS AND METHODS

A German group of clinical experts analyzed the current data and developed criteria for the treatment of mPC patients in daily clinical practice.

RESULTS

In the current treatment of hormone-naïve mPC, a beneficial effect of chemotherapy in addition to ADT has become evident. Provided patients are in an appropriate condition, those with a high metastatic load should receive chemotherapy in addition to ADT. Especially in high-risk mCRPC patients (PSA >114 ng/ml, visceral metastasis, ADT response <12 months, tumor-associated complaints), first-line chemotherapy is indicated. After docetaxel failure, continuous treatment with cabazitaxel shows superior overall survival compared to sustained antihormonal therapy.

CONCLUSION

Chemotherapy is firmly established in treating patients with mCRPC. Long-term, it will be important to identify molecular predictors. The authors suggest the early use of chemotherapy in hormone-naïve mPC, but note that the approval in this indication is currently nonexistent. After disease progression, patients should be treated analogous to mCRPC.

[Chemotherapy of prostate cancer]

The prognosis of patients with advanced prostate cancer has improved over the last few years. In addition to the new antihormonal treatment, chemotherapy with agents such as docetaxel and cabazitaxel has contributed to the improved prognosis. After the introduction of abiraterone and enzalutamide, conventional chemotherapy seemed to become less important but the discussion about the use of chemotherapy for hormone-sensitive prostate cancer has gained attention again. Combining docetaxel with conventional androgen deprivation therapy (ADT) improves survival compared to ADT alone. In addition, docetaxel and cabazitaxel now represent the standard for first and second line therapy in patients with castration-resistant prostate cancer.