What Do We Know About Treatment Sequencing of Abiraterone, Enzalutamide, and Chemotherapy in Metastatic Castration-Resistant Prostate Cancer?

World J Urol. 2016 May;34(5):617-24. doi: 10.1007/s00345-015-1687-0. Epub 2015 Sep 15.


Purpose: To present a systematic review of the different therapeutic sequences in metastatic castration-resistant prostate cancer (mCRPC).

Methods: Evidence acquisition on therapeutic sequences in mCRPC was performed by a MEDLINE search using combination of the following key words: "prostate cancer," "metastatic," "castration resistant," "enzalutamide," "abiraterone," "treatment sequencing," "cabazitaxel," "docetaxel." A total of 17 studies were included for analysis.

Results: Different sequences have been reported for the treatment of mCRPC: docetaxel after abiraterone, cabazitaxel after docetaxel and abiraterone, abiraterone after cabazitaxel and docetaxel, abiraterone after docetaxel and enzalutamide, and enzalutamide after docetaxel and abiraterone. There are arguments from the preclinical observations suggesting a cross-resistance between docetaxel and abiraterone, and between abiraterone and enzalutamide in mCRPC. Despite limitations, several retrospective clinical reports support these data.

Conclusion: No study of high level of evidence is available to support any recommendation on sequential treatment for mCRPC. There are only clues that prospective clinical studies need to confirm.

Keywords: Abiraterone acetate; Cabazitaxel; Cross-resistance; Docetaxel; Enzalutamide; Metastatic castration-resistant prostate cancer; Therapeutic sequence.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Androstenes / administration & dosage*
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Docetaxel
  • Drug Resistance, Neoplasm
  • Drug Therapy, Combination
  • Humans
  • Male
  • Neoplasm Metastasis
  • Phenylthiohydantoin / administration & dosage
  • Phenylthiohydantoin / analogs & derivatives*
  • Prostatic Neoplasms, Castration-Resistant / drug therapy*
  • Prostatic Neoplasms, Castration-Resistant / pathology
  • Taxoids / administration & dosage*


  • Androstenes
  • MDV 3100
  • Taxoids
  • Docetaxel
  • Phenylthiohydantoin
  • cabazitaxel
  • abiraterone