Investigational approaches for the treatment of advanced prostate cancer
- Janet R Walczak, MSN, RN, CRNP
Janet R Walczak, MSN, RN, CRNP
- Roberto Pili, MD
Roberto Pili, MD
- Robert Wallace Miller Professor of Medicine, Director of GU Oncology Division of Hematology/Oncology
- Department of Medicine Professor of Pharmacology and Toxicology Indiana University School of Medicine
- Michael A Carducci, MD
Michael A Carducci, MD
- Aegon Professor of Prostate Cancer Research
- Professor of Oncology and Urology
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- Emmanuel S Antonarakis, MD
Emmanuel S Antonarakis, MD
- Associate Professor of Oncology and Urology
- Sidney Kimmel Comphrehensive Oncology Center
- Johns Hopkins University
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Androgen deprivation therapy (ADT) is highly effective therapy for men with advanced or metastatic prostate cancer, providing at least temporary disease control in over 80 percent of cases. However, the vast majority eventually develop progressive disease.
Once disease progresses, men are considered to have castration-resistant disease. A number of new therapies have been shown to prolong survival in this setting (table 1), but there remains a need for additional approaches that can control disease and prolong survival.
An increasing understanding of the biology of prostate cancer is leading to the development of new therapies that can target specific abnormalities in prostate cancer. Although a number of agents have failed in phase III or randomized phase II trials, other experimental approaches are in advanced stages of development. These are discussed in this topic. The overall approach to men with advanced disease is discussed separately. (See "Overview of the treatment of disseminated castration-sensitive prostate cancer".)
Prostate cancers are frequently characterized by abnormalities in a variety of growth factor signaling pathways that control the cell cycle and apoptosis. As these pathways are being understood, new therapeutic targets are leading to the development of new agents with activity against advanced disease. (See "Molecular biology of prostate cancer".)
Cabozantinib — Cabozantinib is an inhibitor of MET, VEGFR2, and RET. A phase II trial in patients with progressive, metastatic prostate cancer provided preliminary evidence of activity in men with bone metastases [1,2].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Roberto Pili, MD