Dr. Hahn on Patient Selection for Abiraterone Versus Docetaxel in mHSPC

Andy Hahn, MD, resident, University of Utah School of Medicine, discusses patient selection for abiraterone acetate (Zytiga) versus docetaxel in metastatic hormone-sensitive prostate cancer (mHSPC).

Older patients are better suited for abiraterone, as are those with poor performance status, says Hahn. Patients with low-volume disease are also better candidates for the agent. Though the definition of low-volume disease varies across cohorts, Hahn states that this means there is no evidence of visceral disease and patients have less than 5 bony metastases.

Patients who are better candidates for docetaxel are younger patients with good performance status and high-volume disease. Hahn cautions that the agent comes with significant toxicity. Therefore, patients with significant peripheral neuropathy, patients who may have trouble with myelosuppression, and patients who are at increased risk of infection from other co-morbidities should not receive docetaxel.

From the time patients on abiraterone start androgen-deprivation therapy (ADT) to the time they progress to castration-resistant prostate cancer, they will need to take abiraterone daily. Patients on docetaxel will get ADT plus docetaxel for about the first 4 months of treatment before continuing with ADT alone.

The PEACE1 study, which will compare ADT plus abiraterone versus docetaxel in patients with mHSPC, is anticipated to read out in 2020.