Division of Medical Oncology, Department of Oncology, University of Western Ontario, London, Ontario, Canada.
Curr Opin Support Palliat Care. 2011 Sep;5(3):199-205. doi: 10.1097/SPC.0b013e32834903aa.
Patients with metastatic castration-resistant prostate cancer (CRPC) no longer responsive to docetaxel have a poor prognosis, worsened quality-of-life, and traditionally few options for treatment. This review addresses promising and practice-changing developments for the treatment of CRPC in the second-line setting.
Recent data for cabazitaxel, a novel taxane chemotherapy, and abiraterone acetate, a novel inhibitor of androgen synthesis, demonstrate significant improvements in the survival of patients with docetaxel-refractory CRPC. We review the mechanisms of action of these agents and data from phase III clinical trials, contextualizing their place in therapy. We also update other areas of investigation, including oral platinum analogues, vascular-endothelial growth factor receptor targeted therapy, inhibitors of chaperone proteins, and androgen receptor antagonists.
Upon disease progression after first-line docetaxel chemotherapy, cabazitaxel and abiraterone improve survival of patients with CRPC and are important novel treatment options. Potential toxicity from cabazitaxel necessitates careful patient selection and supportive care. Both abiraterone and cabazitaxel are also being evaluated in the first-line setting, and therefore the optimal sequencing of therapies remains uncertain. Many other novel agents continue to be evaluated and promising classes of agents include antisense oligonucleotides against clusterin (custirsen) and androgen receptor antagonists (MDV3100).
对于那些对多西紫杉醇无反应的转移性去势抵抗性前列腺癌（CRPC）患者，预后较差，生活质量恶化，传统的治疗选择很少。这篇综述讨论了二线治疗 CRPC 的有前景且改变实践的新进展。
新型紫杉烷化疗药物卡巴他赛和新型雄激素合成抑制剂阿比特龙在治疗多西紫杉醇耐药的 CRPC 患者的生存方面显示出显著改善。我们综述了这些药物的作用机制和 III 期临床试验数据，将其在治疗中的地位置于背景之中。我们还更新了其他研究领域，包括口服铂类似物、血管内皮生长因子受体靶向治疗、伴侣蛋白抑制剂和雄激素受体拮抗剂。
在一线多西紫杉醇化疗后疾病进展时，卡巴他赛和阿比特龙可改善 CRPC 患者的生存，是重要的新型治疗选择。卡巴他赛的潜在毒性需要仔细的患者选择和支持性护理。阿比特龙和卡巴他赛也都在一线治疗中进行了评估，因此治疗方案的最佳顺序尚不确定。许多其他新型药物仍在评估中，有前途的药物类别包括针对细胞角蛋白的反义寡核苷酸（custirsen）和雄激素受体拮抗剂（MDV3100）。
