Castration Resistant Cancer

MCRPC

(Adenocarcinoma)

MCRPC is castration-resistant prostate cancer with distant metastases

 

Treatment Pathways

GROUP 1 INFORMATION
GROUP 2 INFORMATION
GROUP 3 INFORMATION
GROUP 4 INFORMATION

Treatment Options: Group 1

I. Patient has no prior docetaxel (chemotherapy) treatment, AND no prior treatment with novel hormone therapy (abiraterone, darolutamide, apalutamide, enzalutamide)

  • Preferred regimens
    • Abiraterone, (if no soft tissue metastases)
    • Docetaxel
    • Enzalutamide
  • Useful in certain circumstances (preferred)
    • Niraparib/abiraterone, for BRCA mutation
    • Olaparib/abiraterone, for BRCA mutation
    • Pembrolizumab for MSI-high (MSI-H)/dM)
    • Radium-223 for symptomatic bone metastases
    • Sipuleucel-T
    • Talazoparib/enzalutamide for HRR mutation
  • Other recommended regimens
    • Other secondary hormone therapies
      • First-generation antiandrogen (bicalutamide, flutamide, nilutamide)
      • Corticosteroids (hydrocortisone, prednisone, dexamethasone)
      • Ketoconazole plus hydrocortisone
      • Antiandrogen withdrawl
PROCEED TO GROUP 2

Option Overview

PROCEED TO GROUP 2

Treatment Options: Group 2

II. Patient has prior docetaxel (chemotherapy) treatment, BUT no prior treatment with novel hormone therapy therapy (abiraterone, darolutamide, apalutamide, enzalutamide)

  • Preferred regimens
    • Abiraterone,
    • Cabazitaxel
    • Enzalutamide
  • Useful in certain circumstances
    • Cabazitaxel/carboplatin
    • Mitoxantrone for palliation in symptomatic patients who cannot tolerate other therapies
    • Niraparib/abiraterone, for BRCA mutation
    • Olaparib/abiraterone for BRCA mutation
    • Pembrolizumab for MSI-H/dMMR
    • Radium-223 for symptomatic bone metastases
    • Sipuleucel-T
    • Talazoparib/enzalutamide for HRR mutation
  • Other recommended regimens
    • Other secondary hormone therapies
      • First-generation antiandrogen (bicalutamide, flutamide, nilutamide)
      • Corticosteroids (hydrocortisone, prednisone, dexamethasone)
      • Ketoconazole plus hydrocortisone
      • Antiandrogen withdrawal
PROCEED TO GROUP 3

Option Overview

PROCEED TO GROUP 3

Treatment Options: Group 3

III. Patient has prior treatment with novel hormone therapy (abiraterone, darolutamide, apalutamide, enzalutamide), BUT No prior docetaxel (chemotherapy) treatment

  • ADT with:
    • Preferred therapies
      • Docetaxel
      • Olaparib for BRCA mutation
      • Rucaparib for BRCA mutation
    • Useful in certain circumstances
      • Cabazitaxel/carboplatin
      • Niraparib/abiraterone, for BRCA mutation
      • Olaparib for HRR mutation other than BRCA1/2
      • Pembrolizumab for MSI-H/dMMR or TMB ≥10 mut/Mb
      • Radium-223 for symptomatic bone metastases
      • Sipuleucel-T
      • Talazoparib/enzalutamide for HRR mutation
    • Other recommended therapies
      • Abiraterone
      • Abiraterone plus dexamethasone
      • Enzalutamide
    • Other secondary hormone therapies
      • First-generation antiandrogen (bicalutamide, flutamide, nilutamide)
      • Corticosteroids (hydrocortisone, prednisone, dexamethasone)
      • Ketoconazole plus hydrocortisone
      • Antiandrogen withdrawal
PROCEED TO GROUP 4

Option Overview

PROCEED TO GROUP 4

Treatment Options: Group 4

IV. Patient has prior docetaxel (chemotherapy) treatment, AND prior treatment with novel hormone therapy (abiraterone, darolutamide, apalutamide, enzalutamide)

  • ADT with:
    • Preferred regimens
      • Cabazitaxel
      • Docetaxel rechallenged
    •  Useful in certain circumstances
      • Cabazitaxel/carboplatin
      • Lutetium Lu 177 vipivotide tetraxetan (Lu-177–PSMA-617) for PSMA-positive metastases (preferred)
      • Mitoxantrone for palliation in symptomatic patients who cannot tolerate other therapies
      • Olaparib for HRR mutation  ((preferred for BRCA mutation)
      • Pembrolizumab for MSI-H/dMMR, or TMB ≥10 mut/Mb
      • Radium-223 for symptomatic bone metastases (preferred)
      • Rucaparib for BRCA mutation
    • Other recommended regimens
      • Abiraterone
      • Enzalutamide
      • Other secondary hormone therapies
      • First-generation antiandrogen (bicalutamide, flutamide, nilutamide)
      • Corticosteroids (hydrocortisone, prednisone, dexamethasone)
      • Ketoconazole plus hydrocortisone
      • Antiandrogen withdrawal

Option Overview

CLINICAL TRIALS:
NCCN believes that the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged.

Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer Version 4.2023
© National Comprehensive Cancer Network, Inc. 2022. All rights reserved. The complete and current version of the guideline is available at NCCN.org.

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IMPORTANT:

This information is provided for educational purposes only to support patients in understanding and discussing appropriate treatment options with their doctors. Included is information from treatment guidelines for doctors and other sources. However, this information should not be considered as patient treatment guidelines or recommendations, but as educational materials only. Patients should discuss treatments identified herein with their doctors to understand the risks and benefits of each based on their personal diagnosis. Treatment decisions should only be made between the patient and his doctor.

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