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1、bs_bs_bannerAsia-PacificJournalofClinicalOncology2014doi:10.1111/ajco.12193REVIEWARTICLEChallengesinthesequencingoftherapiesforthemanagementofmetastaticcastration-resistantprostatecancer1,234PhillipPARENTE,FrancisPARNISandHowardGURNEY1MedicalOncology,BoxHillHospita
2、l,BoxHill,Victoria,Australia,2FacultyofMedicine,MonashUniversity,Melbourne,Victoria,Australia,3AdelaideCancerCentre,Adelaide,SouthAustralia,Australia,and4ClinicalResearch,MedicalOncology,WestmeadHospital,Sydney,NewSouthWales,AustraliaAbstractPriorto2010,docetaxelw
3、asthestandardoptionforchemotherapyinmenwithmetastaticcastration-resistantprostatecancer(mCRPC).Today,thepictureisvastlydifferent:severaladditionaltherapieshaveeachdemonstratedasurvivalbenefitsuchthatwenowhavechemotherapy(cabazitaxel),androgensup-pressiveagents(abir
4、ateroneacetateandenzalutamide),acellularvaccine(sipuleucel-T)andradium-233(forsymptomaticbonemetastases).Withseveralotheragentsinthepipelineforlate-stagedisease,thefuturelookspromisingformCRPC.Astheavailabledataarenotabletoinformastotheoptimumsequencingoftherapy,t
5、hisremainsachallenge.Thispaperdrawsoninsightsfrompublishedandongoingclinicalstudiestoprovideapracticalpatient-focusedapproachtomaximizethebenefitsofthecurrenttherapeuticarma-mentarium.Preliminarysequencingsuggestionsaremadebasedonclinicaltrialcriteria.Butuntilmored
6、atabecomeavailable,clinicalgestalt,experience,costandindividualpatientpreferenceswillcontinuetodrivechoices.Keywords:abirateroneacetate,cabazitaxel,enzalutamide,innovativetherapy,prostatecancer.INTRODUCTIONasfirst-linechemotherapysignificantlychangingthe3,4managemen
7、tofmCRPC.Intheintervening8years,Prostatecanceristhemostcommoncancerdiagnosedinfiveadditionaltherapieshaveeachdemonstratedasur-Australianmen,accountingfor30%ofallcancercases,vivalbenefitforpatientswithmCRPC(Table1).Theandrecentprojectionsoutto2020suggestthatitwillman
8、agementofmCRPChasundergoneasignificantandremaintheleadingcauseofcancerinmenformanypositivechange;wenowhavechemotherapy,androgen1yearstocome.Earlydetectio
