There are many options for metastatic castration-resistant prostate cancer (MCRPC), and medical guidelines will recommend new secretory** drugs (such as abiraterone, enzalutamide), taxane chemotherapy drugs (such as docetaxel, cabazitaxel), targeted ** drugs (olaparib, niraparib, etc.), and radionuclide** drugs (such as lutetium-177, radium-223, etc.). Even in developed countries such as the United States, there are very few patients who can use more than two lines of drugs at the MCRPC stage. It can be seen how important it is to choose an effective ** method according to the patient's own situation, because there seems to be no time for us to "trial and error" at this stage.
Another challenge at this stage is the effect of hormone-sensitive medication on the MCRPC stage. Why? Let's first take a general look at the so-called "evidence-based medicine" of Western medicine. Why do medical guidelines recommend many of the above drugs for MCRPCs? Previous clinical studies have shown that patients who take these drugs live longer than those who don't. But one thing we must note is that in the era of clinical research, the main means of hormone-sensitive period is simple endocrine, and we all know that the hormone-sensitive period has entered the "combination era" or "strengthening era", that is, on the basis of simple endocrine** plus a new secretory ** drug (double**) or even on the basis of simple endocrine ** plus a new endocrine ** drug plus chemotherapy (triple ** There is no standard answer to what happens to these patients after they enter the MCRPC! The 2024 American Oncology Annual Meeting (ASCO GU) has set up a special session to discuss the best means for this part of the patient.
Series 1 – Switching to a new endocrine** drug or chemotherapy?
The first foreign scholar to appear put forward the idea that for patients who have used the intensive ** mode during the hormone-sensitive period, they can consider changing to another new type of endocrine ** drug, or using chemotherapy. Previous studies of the new endocrine drug in the MCRPC stage have shown that even if a patient becomes resistant to a new type of endocrine ** drug, switching to another can still have a certain effect. For example, after abiraterone failure, replacing enzalutamide can reduce the PSA by more than half in 36% of patients, but after the failure of abiralumide, the effect of replacing abiraterone is very poor, and only 4% of patients can reduce the PSA to more than half.
Will chemotherapy be more effective? The scholar further cited the data from the card study. In the CARD study, patients with MCRPC who failed to secrete a new type of secretion** were divided into two groups and received chemotherapy with either a new type of secretion** or cabazitaxel. The results showed that the ** effect of cabazitaxel was significantly better than that of changing to a new endocrine ** drug. Notably, in the CARD study, all enrolled patients were severely ill, with more than 70% of patients having symptoms of bone pain. In addition, data from some retrospective studies have also shown that patients who have progressed to MCRPC and then treated docetaxel chemotherapy in the hormone-sensitive phase have a better response**.
Therefore, the scholar believes that patients who have previously received a double or triple ** during the hormone-sensitive phase need to be fully evaluated after entering the MCRPC stage. If the patient has significant bone pain symptoms, chemotherapy is a better option. For patients without significant pain symptoms, a change to another newer endocrine drug may be considered, but the scholar recommends that it should be changed as soon as possible if it is to be replaced.
Highlights:
1) There is no clear consensus on what method should be used after progression to the MCRPC stage for patients who have previously received double** or triple** in the hormone-sensitive period;
2) chemotherapy and replacement of another new endocrine patient** are options to consider;
3) Chemotherapy is recommended for patients with obvious pain symptoms, and for patients without obvious pain, another new endocrine ** drug can be considered and changed as soon as possible.