State-of-the-Art Treatment of Metastatic Hormone-Refractory Prostate Cancer

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Abstract
Learning Objectives: After completing this course, the reader will be able to:Identify agents which have shown activity in the treatment of hormone refractory prostate cancer (HRPC).Recognize the mechanisms of resistance to chemotherapy in HRPC, including genetic alterations commonly found in advanced disease.Recognize the development of novel approaches to the treatment of HRPC. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com Initial therapy for advanced prostate cancer includes androgen ablation by surgical or medical castration. Still, nearly all men with metastases will progress to hormone-refractory prostate cancer (HRPC). Current U.S. Food and Drug Administration-approved agents for the treatment of HRPC include mitoxantrone and estramustine, although the vinca alkaloids and the taxanes have shown promising activity in single-agent phase II trials. Combinations of these agents induce a biochemical response in greater than 50% of patients, but the median duration of response is approximately 6 months. Overall survival of patients treated with these combinations is approximately 18-24 months. Studies are ongoing to develop novel therapies that target specific molecular pathways or mechanisms of chemotherapy resistance. Novel agents under development include growth factor receptor inhibitors, antisense oligonucleotides, bisphosphonates, and cell differentiating agents. Evaluation and incorporation of these agents into existing treatment regimens will guide us in the development of more active regimens in the treatment of HRPC.