Optimizing the treatment of metastatic castration-resistant prostate cancer: a Latin America perspective

Abstract

Prostate cancer is a significant burden and cause of mortality in Latin America. This article reviews the treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC) and provides consensus recommendations to assist Latin American prostate cancer specialists with clinical decision making. A multidisciplinary expert panel from Latin America reviewed the available data and their individual experience to develop clinical consensus opinions for the use of life-prolonging agents in mCRPC, with consideration given to factors influencing patient selection and treatment monitoring. There is a lack of level 1 evidence for the best treatment sequence or combinations in mCRPC. In this context, consensus recommendations were provided for the use of taxane-based chemotherapies, androgen receptor axis-targeted agents and targeted alpha therapy, for patients in Latin America. Prostate-specific antigen (PSA) changes alone, during treatment, should be treated with caution; PSA may not be a suitable biomarker for radium-223. Bone scans and computed tomography are the standard imaging modalities in Latin America. Imaging should be prompted during treatment where symptomatic decline and/or significant worsening of laboratory evaluations are reported, or where a course of therapy has been completed and another antineoplastic agent is under consideration. Recommendations and guidance for treatment options in Latin America are provided in the context of country-level variable access to approved agents and technologies for treatment monitoring. Patients should be treated with the purpose of prolonging overall survival and preserving quality of life through increasing the opportunity to administer all available life-prolonging therapies when appropriate.Electronic supplementary materialThe online version of this article (10.1007/s12032-018-1105-8) contains supplementary material, which is available to authorized users.

Cancer mortality predictions for 2019 in Latin America

“…Prostate cancer mortality rates in LA were higher compared to those of the EU and North America and are predicted to be among the highest worldwide. However, they showed favourable trends for most countries up to 2019, likely due to improvements in treatment, and early diagnosis . Similarly to other cancers, progress on prostate cancer was however smaller than in high‐income areas of the world.…”

AR-V7 as a Biomarker for Resistance to Treatment with Abiraterone/Enzalutamide in Three Latin American Countries: A Hypothetical Cost-Saving Analysis

“…Prostate cancer is the most common male cancer in Latin America and one of the top causes of cancer mortality in many of these countries [2]. The development and implementation of diagnostic and therapeutic tests based on the detection of new molecular biomarkers in peripheral blood for prostate cancer has the potential to improve patient management.…”

“…The clinical management algorithm for CRPC was adapted from the recommendations in Sade et al [2], which are based on the guidelines by the European Society of Medical Oncology, the National Comprehensive Cancer Network (NCCN), the American Urological Association, and the American Society of Clinical Oncology and applied to the Latin American context. Abiraterone acetate dose was defined as 1,000 mg p.o.…”

“…Regardless of the potential benefits of using treatment indicator biomarkers for prostate cancer, their clinical implementation faces great challenges in Latin America. Some of the barriers include difficulty of access to new technologies and medicines, key structural and organizational limitations of health systems, unequal distribution of resources destined for treatment and research in cancer, and lack of knowledge about new technologies and therapeutic possibilities among the different health system actors [2,14].…”

“…Patients with recurrent disease are considered to have castration‐resistant prostate cancer (CRPC). Therapeutic options in this subgroup of patients include taxane chemotherapy, androgen receptor (AR)‐axis–targeted therapy, targeted alpha therapy (Radium‐223), and Sipuleucel T [2].…”