The third line of treatment for metastatic prostate cancer patients: Option or strategy?

•Abiraterone acetate and enzalutamide had a modest response rate when administered as a third line of therapy.•Cabazitaxel seems to retain its activity in third line of treatment.•On the basis of all of the available data, no specific third line can be recommended.•Large randomized trials are warranted to determine the usefulness of a third line of treatment for castration resistant prostate cancer patients.

SummaryNew agents for metastatic castration-resistant prostate cancer (CRPC) developed in the past 3 years include cabaziataxel (Cbz), abiraterone acetate (AA) and enzalutamide (E). In this review, the results of clinical studies in which one of these drugs is included as the third line of treatment are discussed. Our review suggests that AA and E have limited activity, while Cbz seems to retain its efficacy. Prospective studies that further examine sequential treatments are warranted.