Dr. Kohli on Sequencing Concerns in Metastatic Hormone-Sensitive Prostate Cancer

Manish Kohli, MD, vice chair, Department of Genitourinary Oncology, Moffitt Cancer Center, discusses sequencing concerns in metastatic hormone-sensitive prostate cancer (mHSPC).

There are several treatment options available for patients with mHSPC, including docetaxel, apalutamide (Erleada), and abiraterone acetate (Zytiga). Some patients will receive docetaxel within the first 6 months of starting androgen deprivation therapy (ADT). If they progress, they can be re-challenged with docetaxel, or given abiraterone or enzalutamide. On the other hand, if an AR inhibitor is given upfront with ADT and the patient progresses, treatment would be limited to docetaxel, explains Kohli.

It is important to establish the optimal sequencing on an individualized basis, he adds. Access to these agents will also have to be assessed as these drugs are costly. For example, a cost analysis was done between abiraterone and docetaxel in the hormone-sensitive setting, and it was clear that docetaxel is the cheaper option; however, docetaxel is slightly more toxic than abiraterone. These factors will have to be taken into consideration, says Kohli. Biomarkers could help clarify sequencing decisions, but the field has not reached that point yet.