Dr. Petrylak on Sequencing Prostate Cancer Therapies

Daniel P. Petrylak, MD, Professor of Medicine, Co-Leader of Prostate Cancer, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses a need to create a solid guideline for sequencing castrate-resistant prostate cancer (CRPC) therapies.

Petrylak explains there is currently very little information to help clinicians determine the order of treatment for CRPC. There are 5 drugs that are currently on the market, or will soon be on the market, for very similar clinical niches within this disease. These drugs include the chemotherapy microtubule inhibitor cabazitaxel (Jevtana), androgen receptor antagonists such as the recently approved abiraterone acetate (Zytiga) and the investigatory MDV3100, the exploratory alpha-emitting radiopharmaceutical radium-223 (Alpharadin), and the immunotherapy sipuleucel-T (Provenge) that can be given to patients that fail docetaxel (Taxotere), or have had one docetaxel regimen.

Without a thorough understanding of the biology of these drugs it is difficult to know how they should be sequenced. Petrylak feels that a test should be developed that indicates which drug or treatment is the best in any given situation. Without a test clinicians can only use their best judgment and usually prescribe chemotherapy to rapidly progressive patients and hormonal agents for chemotherapy resistance.

The lack of a scientific method to decide the treatment has led to disappointment within the oncology community and will be the focus of study in the future.