Looking to the future: Advances in the management of hormone-refractory prostate cancer

At present there are no effective treatment options for patients with hormone-refractory prostate cancer (HRPC) and current medical management is largely palliative. Therefore, there is a need for novel, non-cytotoxic treatment approaches in HRPC. Cancer development is a multistep process, involving initiation, proliferation, angiogenesis, invasion, and metastasis, each of which present potential targets for anticancer therapy. A number of agents exploiting each of these cellular targets are in clinical development and are reviewed in this article, particularly: inhibitors of the epidermal growth factor signalling cascade (e.g. cetuximab, trastuzumab, and ZD1839 ['Iressa']); endothelin-A receptor antagonists (e.g. atrasentan); and angiogenesis inhibitors (e.g. ZD6474 and PTK 787). Other potential approaches include novel uses of existing compounds, inhibition of invasion/metastasis, induction of apoptosis, and gene therapy. These novel approaches and agents have the potential to be used in sequence or combination with established therapies, but also in combination with other new treatments. New, targeted biological therapies should lead to many more therapeutic options and better outcomes for patients with prostate cancer, particularly those with HRPC. (C) 2002 Elsevier Science B.V. All rights reserved.