Prostate cancers that progress despite androgen deprivation develop into castration-resistant prostate cancer, a fatal disease with few treatment options. In this review, we discuss the current understanding of prostate cancer subtypes and alterations in the DNA damage response (DDR) that can predispose to the development of prostate cancer and affect its progression. We identify barriers to conventional treatments, such as radiotherapy, and discuss the development of new therapies, many of which target the DDR or take advantage of recurring genetic alterations in the DDR. We place this in the context of advances in understanding the genetic variation and immune landscape of CRPC that could help guide their use in future treatment strategies. Finally, we discuss several new and emerging agents that may advance the treatment of lethal disease, highlighting selected clinical trials.
尽管经过雄激素剥夺治疗仍进展的前列腺癌会发展为去势抵抗性前列腺癌,这是一种治疗选择极少的致命疾病。本综述探讨了当前对前列腺癌亚型的认识,以及可能诱发前列腺癌发生并影响其进展的DNA损伤反应(DDR)相关改变。我们分析了传统治疗方法(如放疗)面临的障碍,并讨论了新型疗法的研发进展——其中多数疗法以DDR为靶点或利用DDR中反复出现的遗传变异。同时,我们将这些进展置于对CRPC遗传变异和免疫微环境认知不断深化的背景下,这些认知可能有助于指导未来治疗策略的制定。最后,我们讨论了数种可能推动致命性疾病治疗进展的新型药物,并重点介绍了部分临床试验。
Exploiting the DNA Damage Response for Prostate Cancer Therapy