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Natural History of Prostate Cancer Local therapy Androgen deprivation therapy (ADT) Therapies after ADT Death ADT mCRPC post- docetaxel mCRPC symptomatic.

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Presentation on theme: "Natural History of Prostate Cancer Local therapy Androgen deprivation therapy (ADT) Therapies after ADT Death ADT mCRPC post- docetaxel mCRPC symptomatic."— Presentation transcript:

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2 Natural History of Prostate Cancer Local therapy Androgen deprivation therapy (ADT) Therapies after ADT Death ADT mCRPC post- docetaxel mCRPC symptomatic mCRPC mildly symptomatic mCRPC asymptomatic (failed ADT) Hormone sensitive ADT + Docetaxel in high volume disease?

3 Definition of CRPC 2014

4 Definition of CRPC 2013

5 EAU Guidelines – 2014 edition

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7 Mod. da Nelson et al, J Clin Oncol 2012 Il processo di progressione tumorale nel CaP Autoproduzione di Testosterone TARGET: CYP17 Attivazione di AR aspecifica Totalmente dipendente da testosterone circolante ADT Androgeno indipendente AR indipendente

8 Enzalutamide Reduced Risk of Death by 29% Enzalutamid e 87 2 Placeb o Duration of Overall Survival (Months) Survival (%) Enzalutamide Placebo Hazard Ratio: (95% CI: 0.60,0.84) P< Patients at Risk Patients still alive at data cut off Enzalutamide: 72%; Placebo: 63% Enzalutamide: 241 deaths Placebo: 299 deaths Beer et al, N Engl J Med. 2014; 371(5): Placebo: 30.2 (95% CI 28.0, NYR) Enzalutamide: 32.4 (95% CI 30.1, NYR) Median Follow-up 22 Months

9 Final OS Analysis Median follow-up of 49.2 months Abiraterone treatment effect more pronounced when adjusting for 44% of prednisone patients who received subsequent abiraterone (HR = 0.74) Ryan C et al. ESMO 2014; Abstract 7530 (oral presentation)

10 Current Treatment Paradigm is Evolving Local therapy Androgen deprivation therapy (ADT) Therapies after ADT Death ADT supportive care (eg denosumab/bisphosphonates) mCRPC post- docetaxel mCRPC symptomatic mCRPC mildly symptomatic mCRPC asymptomatic (failed ADT) Hormone sensitive Sipuleucel-T Enzalutamide Abiraterone Docetaxel Cabazitaxel Radium 223 Enzalutamide ADT + Docetaxel in high volume disease?


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