Drug Intensification in Future Postoperative Radiotherapy Practice in Biochemically-Relapsing Prostate Cancer Patients

Axel Cailleteau; Paul Sargos; Fred Saad; Igor Latorzeff; Stéphane Supiot

doi:10.3389/fonc.2021.780507

Drug Intensification in Future Postoperative Radiotherapy Practice in Biochemically-Relapsing Prostate Cancer Patients

Front Oncol. 2021 Dec 24:11:780507. doi: 10.3389/fonc.2021.780507. eCollection 2021.

Authors

Axel Cailleteau¹, Paul Sargos², Fred Saad³, Igor Latorzeff⁴, Stéphane Supiot^{1

5}

Affiliations

¹ Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes Saint-Herblain, France.
² Department of Radiation Oncology, Institut Bergonié, Bordeaux, France.
³ Department of Urology, Université de Montréal, Montreal, QC, Canada.
⁴ Department of Radiation Oncology, Oncorad Clinique Pasteur, Toulouse, France.
⁵ University of Nantes, CRCINA (CNRS, Inserm), Nantes, France.

Abstract

Although salvage prostate bed radiotherapy is highly effective in biochemically-relapsing prostate cancer patients following prostatectomy, relapses remain frequent and improvements are needed. Randomized phase 3 trials have shown the benefit of adding androgen-depriving therapy to irradiation, but not all patients benefit from this combination. Preclinical studies have shown that novel agents targeting the androgen receptor, DNA repair, PI3K/AKT/mTOR pathways, or the hypoxic microenvironment may help increase the response to prostate bed irradiation while minimizing potential side effects. This perspective review focuses on the most relevant molecules that may have an impact when combined with salvage radiotherapy, and underlines the strategies that need to be developed to increase the efficacy of salvage post-prostatectomy radiotherapy in prostate cancer patients.

Keywords: PARP inhibitors; androgen receptor (AR) antagonist; combined treatment; radiosensitizing agents; salvage prostate bed radiotherapy.