Epothilones in prostate cancer

Objectives: Treatment options for castration-resistant prostate cancer (CRPC) are limited. Although taxane-based regimens offer limited survival benefits, patients frequently relapse, and there are no standard regimens beyond progression. The epothilones represent a new class of chemotherapeutics that stabilize microtubules but have a distinct mechanism of action to the taxanes and low susceptibility to drug resistance. This article seeks to provide a review of what is currently known about the preclinical and clinical activity of this emerging class of agents.

Materials and methods: A literature search was conducted using PubMed and congress abstract databases to identify clinical data relevant to the epothilones and their use in CRPC. Preference was given to recently published, well-designed preclinical reports and clinical studies.

Results: Preclinical activity has been shown for several epothilones in taxane-resistant cell lines across several tumors, including CRPC. Ixabepilone, sagopilone, and patupilone have demonstrated clinical activity and tolerability in phase II CRPC trials.

Conclusion: The epothilones have demonstrated efficacy in CRPC, and ongoing studies will help define their roles in this disease state, including optimal dosing, combination regimens, and clinical biomarkers of response.