Page 8 - Uro_Onco_booklet

Part 4: Sequencing Treatment in mCRPC

No. Statements
After first-line docetaxel / AR pathway inhibitor fails, the
following factors should be considered when deciding
on a second-line treatment:
a. Patient's fitness / performance status (i.e. ECOG 0-1
vs ECOG 2)
b. Age (i.e. < 75 years vs ≥ 75 years)
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c. Time to disease progression after initial
chemotherapy / AR pathway inhibitor (during or ≤
3 months vs > 3 months)
d. Clinical symptoms, such as bone pain and
complications arising from the metastatic lesions
e. Presence of visceral metastases
If first-line docetaxel fails, second-line treatment
options include AR pathway inhibitors, cabazitaxel
or radium-223. Cabazitaxel should be considered in
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patients who are less likely to respond to AR pathway
inhibitors, such as those with a high Gleason score (i.e.
8 to 10).
Radium-223 is indicated for the treatment of mCRPC
patients with symptomatic bone metastases and no
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known visceral metastatic disease, with or without prior
chemotherapy.
There is no evidence to show a major cross-resistance
between radium-223 and other systemic agents.
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However, the sequencing between radium-223 and
other systemic agents remains undetermined.

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