Dr. Penson on Questions Regarding Next-Generation AR Inhibitors in Prostate Cancer

David F. Penson, MD, MPH, MMHC, chair, Department of Urology, and Paul V. Hamilton, MD and Virginia E. Howd Chair, Urologic Oncology, at Vanderbilt University Medical Center, discusses questions regarding next-generation androgen receptor (AR) inhibitors in prostate cancer.

Questions regarding the use of AR inhibitors extend beyond the metastatic setting, says Penson. For example, does a patient with low volume oligometastatic disease need local therapy in addition to a next-generation AR inhibitor? Preliminary data suggest that local therapy may help improve patient outcomes, says Penson.

In the localized setting, should next-generation AR inhibitors be used in the neoadjuvant or adjuvant settings? Historically, neoadjuvant hormone therapy wouldn’t have been considered prior to local therapy, says Penson. Now, investigators believe that the newer agents could be beneficial as neoadjuvant therapy. This will be the subject of further exploration in the coming years, adds Penson.

Because many of the AR inhibitors have the same mechanism of action, investigational strategies should seek to define combinations that target different pathways, concludes Penson.