Nat. Rev. Clin. Oncol. doi: /nrclinonc

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Nat. Rev. Clin. Oncol. doi:10.1038/nrclinonc.2016.181 Figure 2 Treatment cycling to prevent progression to treatment-induced mCRPC Figure 2 | Treatment cycling to prevent progression to treatment-induced mCRPC. a | Prostate tumours are heterogeneous (left) but are often treated with drugs targeting a single oncogenic mechanism, until a clinical response is no longer obtainable. This approach can lead to toxicity, loss of drug sensitivity, and the accumulation of multidrug-resistant cancer cells. b | Rapid cycling of agents that target cancer cells might enable sustained drug sensitivity through different resistance mechanisms while, at the same time, controlling prostate cancer progression through the suppression of oncogenic signalling. Thus, the use of this approach can maintain drug sensitivity and continued growth inhibition. c | In the Prostate Cancer Intensive Non-crossreactive Therapy (PRINT) clinical trial23, men with metastatic castration-resistant prostate cancer (mCRPC) will receive different specific treatments in cyclical modules, each for 12 weeks. Module one is comprised of androgen receptor (AR)-targeted therapy (abiraterone) and α radiation (223Ra), module two consists of cytotoxic agents (cabazitaxel and/or carboplatin), and module three consists of androgen receptor (AR)- targeted therapy (enzalutamide) and α radiation (223Ra). Progression will be assessed after completion of modules one to three, with the option of performing additional cycles. Roubaud, G. et al. (2016) Strategies to avoid treatment-induced lineage crisis in advanced prostate cancer Nat. Rev. Clin. Oncol. doi:10.1038/nrclinonc.2016.181