The availability of new drugs capable of improving the overall survival of patients with metastatic
castration-resistant prostate cancer has led to the possibility of using them sequentially in the
hope of obtaining a cumulative survival benefit. The new agents have already been administered as
third-line treatments in patients who have previously received them as second line in everyday clinical
practice, but the efficacy of this practice is not yet supported by clinical trial data, and evidence of possible
cross-resistance has reinforced the debate concerning the best sequence to use in order to maximise
the benefit. Furthermore, the situation is further complicated by the possibility of administering
new hormonal agents to chemotherapy-naïve patients, and novel chemotherapeutic agents to hormone-sensitive patients.
This article critically reviews the available data concerning the sequential use of new drugs, and discusses the real evidence
concerning their optimal positioning in the therapeutic strategy of metastatic castration-resistant prostate cancer.
Keywords: Castration-resistant prostate cancer, sequence, first-line, second-line, docetaxel, abiraterone acetate, cabazitaxel.
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