Treatment of Advanced Prostate Cancer: Where Are We in 2019?

ABSTRACT

In the last decade, important advances have been made in the treatment of metastatic prostate cancer, resulting in a better understanding of the biology underlying the disease, and in the approval of several therapeutic agents such as immunotherapy, new generation antiandrogens, cytotoxic chemotherapies, and radiopharmaceuticals. All these recent advances have been incorporated in clinical guidelines and a critical analysis of the data available should be important to help the decision-making process. In addition, the incorporation of well established therapies in early disease stages have demonstrated a robust overall survival gain for patients with castration-sensitive metastatic prostate cancer. However, no predictive biomarkers of response are available and the selection of the best therapeutic option is still challenging depending on clinical and pathological factors. Many questions related to the optimal sequencing of agents, or comparison of its efficacy remain unanswered.

RESUMO

Na última década, tem havido avanços importantes no tratamento de câncer de próstata metastático, o que resultou em uma melhor compreensão da biologia subjacente da doença e a aprovação de vários agentes terapêuticos, tais como imunoterapia, nova geração anti-andrógenos, quimioterapias citotóxicas e radiofármacos. Todos esses avanços recentes foram incorporados às diretrizes clínicas e uma análise crítica dos dados disponíveis seria importante para ajudar no processo de tomada de decisão. Além disso, a incorporação de terapias bem estabelecidas nos estágios iniciais da doença demonstrou um aumento robusto na sobrevida global em pacientes com câncer de próstata metastático sensível à castração. No entanto, não existem biomarcadores preditivos de resposta disponíveis e a seleção da melhor opção terapêutica permanece um desafio, dependendo dos fatores clínicos e patológicos. Muitas questões relacionadas ao sequenciamento ótimo de agentes ou à comparação de sua eficácia permanecem sem resposta.

Keywords:

Prostate - Review/drug therapy - Receptors - Androgen - Androgen Antagonists - Advanced Treatment - Prostate-Specific Antigen

Descritores:

Próstata - Revisão/terapia medicamentosa - Receptores Androgênicos - Antagonistas de andrógenos - Tratamento Avançado - Antígeno específico da próstata

AUTHOR'S CONTRIBUTION

Fernando Sabino Marques Monteiro: Collection and assembly of data, Conception and design, Data analysis and interpretation, Final approval of manuscript, Manuscript writing, Provision of study materials or patient

Andrey Soares: Data analysis and interpretation, Final approval of manuscript, Manuscript writing

Fernando Nunes Galvão de-Oliveira: Final approval of manuscript, Manuscript writing

Pedro Castilhos de Freitas Crivelaro: Manuscript writing

Pablo Moura Barrios: Manuscript writing

Andre Poisl Fay: Conception and design, Data analysis and interpretation, Final approval of manuscript, Manuscript writing

Publication History

Received: 19 July 2018

Accepted: 13 March 2019

Article published online:
15 April 2019

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