Dr. George on Sequential Therapy in Metastatic Prostate Cancer

Daniel J. George, MD, professor of Medicine and Surgery, member, Duke Cancer Institute, discusses sequential therapy in metastatic prostate cancer.

For patients with metastatic hormone-sensitive prostate cancer, physicians are combining docetaxel-based therapies or secondary hormonal therapies, says George. Moving forward, there may be an opportunity to combine both of those agents together, especially in patients with high-volume, extensive-stage disease.

For patients with metastatic castration-resistant prostate cancer (mCRPC) who have progressed on agents such as abiraterone acetate (Zytiga) or enzalutamide (Xtandi), physicians are faced with selecting the optimal second-line therapy. Prognostic factors and tumor burden are 2 big components that must be considered, says George. Within this population, there are patients with a high tumor burden who are going undetected, and, as a result, are not receiving therapy that is aggressive enough. Mild progression of symptoms is still progression, he adds. Following progression on frontline therapy, the median survival of a patient with mCRPC is 18 months. By being cognizant of these changes, physicians can take a more proactive approach and try to maintain a patient’s performance status at 0 or 1 for as long as possible.