Tuesday, March 24, 2015

NCCN Guidance on New Castration-Resistant Prostate Therapies Neil Osterweil March 17, 2015 part 2

The NCCN guidelines note that as disease progresses, men with metastatic prostate cancer could benefit from a sequence of therapies.
Options for Initial Therapies in the Sequence
The established anti-androgenic agents bicalutamide, flutamide, and nilutamide, and the newer agent enzalutamide (Xtandi, Astellas Pharma)
Androgen synthesis inhibitors such as ketoconazole and abiraterone acetate (Zytiga, Janssen Biotech)
Immunotherapy with sipuleucel-T (Provenge, Dendreon Corp.)
Chemotherapy with docetaxel (Taxotere and generics), cabazitaxel (Jevtana, sanofi-aventis), or mitoxantrone
Radiopharmaceutical therapy with radium-223
Investigational options
Supportive care with bone support (bisphosphonates and denosumab [Xgeva, Amgen]), as well as exercise, sunlight, vitamin D and calcium supplementation, palliative radiation, and/or radiopharmaceuticals

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