Onkológia 4/2023

Review on castrate-resistant prostate carcinoma systemic therapy

This review is focused on summary of phase 3 studies´ results, which determine current treatment options for castrate-resistant prostate cancer (CRPC). Men with high-risk non-metastatic CRPC should be treated with continued androgen-deprivation therapy (ADT) in combination with apalutamide, darolutamide, or enzalutamide. For first-line metastatic CRPC, we have several options: docetaxel (symptomatic patients), abiraterone, enzalutamide, or sipuleucel T (asymptomatic or minimally symptomatic men), and the combinations of poly(ADP-ribose)-polymerase inhibitors (PARPi niraparib or olaparib) with abiraterone (EMA approved) and talazoparib with enzalutamide (FDA approved). The second-line options include abiraterone, enzalutamide, taxanes (docetaxel and cabazitaxel), radionuclide therapies (Radium-223 and Lutetium-177-PSMA-617), and PARPi in monotherapy (EMA-approved olaparib and FDA-approved rucaparib), if BRCA1/2 mutations are present.

Keywords: prostate cancer, resistance to castration, new hormonal therapies, radionuclides, poly(ADP-ribose)-polymerase inhibitors