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Pharmacotherapeutic Management of Locally Advanced Prostate Cancer

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Abstract

Locally advanced prostate cancer (LAPC) is a heterogeneous entity usually embracing T3-4 and/or pelvic lymph-node-positive disease in the absence of established metastases. Outcomes for LAPC with single therapies have traditionally been poor, leading to the investigation of adjuvant therapies. Prostate cancer is a hormonally sensitive tumour, which usually responds to pharmacological manipulation of the androgen receptor or its testosterone-related ligands. As such, androgen deprivation therapy (ADT) has become an important adjuvant strategy for the treatment of LAPC, particularly for patients managed primarily with radiotherapy. Such results have generally not been replicated in surgical patients. With increased use of ADT has come improved awareness of the numerous toxicities associated with long-term use of these agents, as well as the development of strategies for minimizing ADT exposure and actively managing adverse effects. Several trials are exploring agents to enhance radiation cell sensitivity as well as the application of adjuvant docetaxel, an agent with proven efficacy in the metastatic, castrate-resistant setting. The recent work showing activity of cabazitaxel, sipuleucel-T and abiraterone for castrate-resistant disease in the post-docetaxel setting will see these agents investigated in conjunction with definitive surgery and radiotherapy.

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Acknowledgements

No funding was received for the preparation of this article. Jarad Martin has received honoraria from Ferring, Novartis and Abbott. He also has grant applications pending with Abbott for investigator-initiated research. Stephane Supiot received honoraria and consultancies from Sanofi-Aventis, Novartis and Ipsen Pharma, and was awarded a research grant from Astra-Zeneca. Dominik Berthold reports that he has no conflict of interest that is directly relevant to the content of this manuscript.

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  1. Toowoomba Cancer Research Centre, St Andrews Cancer Care Centre, Toowoomba, Queensland, Australia

    Jarad M. Martin

  2. Centre De Lutte Contre Le Cancer Nantes-Atlantique, Centre René Gauducheau, Nantes, France

    Stephane Supiot

  3. Centre Pluridisciplinaire d’Oncologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Dominik R. Berthold

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  1. Jarad M. Martin
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  2. Stephane Supiot
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  3. Dominik R. Berthold
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Correspondence to Jarad M. Martin.

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Martin, J.M., Supiot, S. & Berthold, D.R. Pharmacotherapeutic Management of Locally Advanced Prostate Cancer. Drugs 71, 1019–1041 (2011). https://doi.org/10.2165/11591500-000000000-00000

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