Dr Gong on the Current Treatment Armamentarium in mHSPC

Jun Gong, MD, medical director, Colorectal Cancer; associate professor, medicine; medical oncologist, Gastrointestinal Disease Research Group, Pancreatic Cancer Research Group, Urologic Oncology Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Cancer, discusses the current treatment armamentarium for patients with metastatic hormone-sensitive prostate cancer (mHSPC), highlighting the use of triplet therapeutic options.

mHSPC accounts for only a small percentage of newly diagnosed prostate cancer cases, as most patients present with localized disease, Gong begins. However, patient prognosis significantly worsens with metastatic disease, dropping from an approximately 90% 5-year overall survival (OS) rate with localized disease to an OS rate of less than 40%, he states. mHSPC management historically involved androgen deprivation therapy (ADT) alone, but over the past decade, there has been a shift toward the intensification of ADT through the incorporation of additional agents, Gong explains.

These additional agents include docetaxel, androgen receptor signaling inhibitors (ARSIs) such as abiraterone acetate (Zytiga), and enzalutamide (Xtandi), he expands. Furthermore, recent phase 3 trials, such as PEACE1 (NCT01957436) and ARASENS (NCT02799602), have investigated triplet therapy—ADT plus docetaxel plus an ARSI—which has become a new standard of care (SOC), particularly for high-volume de novo mHSPC, despite the increased adverse effects, he adds. However, questions remain about the optimal use of these triplet therapies. For example, it is still unknown how to best identify which patients may benefit from treatment intensification with a triplet therapeutic approach in mHSPC.

The PEACE1 trial was a multicenter study comparing the clinical benefit of SOC ADT with or without docetaxel alone vs SOC plus local radiotherapy vs SOC plus abiraterone vs SOC plus radiotherapy and abiraterone in mHSPC. Conversely, the purpose of the ARASENS study was to assess the efficacy and safety of darolutamide (Nubeqa) in combination with standard ADT and docetaxel in this patient population. This intensified treatment approach has shown superior outcomes compared with traditional chemotherapy-based doublet therapy, especially in specific subsets of patients, Gong concludes.