Second-line therapy for castrate-resistant prostate cancer: a literature review

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.

The complex interplay between cholesterol and prostate malignancy

Research into the role of cholesterol and prostate disease has been ongoing for many years, but our mechanistic and translational understanding is still poor. Recent evidence indicates that cholesterol-lowering drugs reduce the risk of aggressive prostate cancer. This article reviews the literature on the relationship between circulating cholesterol and prostate cancer. The data strongly point to hypercholesterolemia as a risk factor for prostate cancer progression and suggest clinical opportunities for the use of cholesterol-lowering therapies to alter disease course.

The role of abiraterone acetate in the management of prostate cancer: a critical analysis of the literature

CONTEXT

The development of agents targeting androgen signalling holds promise for men with castration-resistant prostate cancer (CRPC).

OBJECTIVE

The emerging role of abiraterone acetate (AA), a novel, orally administered androgen synthesis inhibitor, is critically analysed.

EVIDENCE ACQUISITION

Data were acquired from critically important original research published in peer-reviewed literature or presented at conferences conducted by the American Society of Clinical Oncology and the European Society of Medical Oncology.

EVIDENCE SYNTHESIS

The major findings are addressed in an evidence-based, objective, and balanced fashion.

CONCLUSIONS

AA specifically inhibits CYP17 and substantially reduces serum androgen levels without inducing significant adrenal insufficiency. A phase 3 trial reported a significant extension of survival in metastatic CRPC with AA plus prednisone compared to prednisone alone following docetaxel. The primary toxicity of mineralocorticoid excess is manageable. The addition of low-dose corticosteroids to AA may be necessary for controlling symptoms of mineralocorticoid excess.