Dr. Penson on Treatment Selection in Metastatic Hormone-Sensitive 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 treatment selection in patients with metastatic hormone-sensitive prostate cancer.

Several FDA-approved agents are indicated for patients with mHSPC, including apalutamide (Erleada), abiraterone acetate (Zytiga), and docetaxel. Notably, the FDA granted a priority review designation to a supplemental new drug application for enzalutamide (Xtandi) for the treatment of patients with metastatic hormone-sensitive disease, based on data from the phase III ARCHES and ENZAMET trials.

Given the number of agents that are available in this setting, treatment can be individualized to each patient. For example, patients who have epilepsy would not do well on enzalutamide, says Penson. If the patient is a frail diabetic, they may not do well on abiraterone or docetaxel. If a patient has a high volume of disease, they may respond better to docetaxel over one of the androgen receptor—signaling inhibitors, adds Penson.