Dr Wise on the Deciding Between Doublet and Triplet Regimens in Prostate Cancer

David R. Wise, MD, PhD, assistant professor, Department of Medicine, Department of Urology, NYU Grossman School of Medicine, director, Genitourinary Medical Oncology, NYU Langone Health’s Perlmutter Cancer Center, NYU Langone Health, discusses considerations for the use of doublet or triplet regimens for the treatment of patients with prostate cancer.

Although triplet therapy has been established as an effective treatment option for patients with prostate cancer who have high-volume disease, unanswered questions remain regarding which patients could experience similar benefit with the use of a doublet, Wise begins. Additionally, more data are needed to identify which patients could benefit more from a hormone therapy–based doublet or a chemotherapy-based doublet, he adds. Quality-of-life data have demonstrated that hormone therapy–doublets are linked with improved quality of life compared with chemotherapy, Wise explains.

Another key question surrounds the addition of chemotherapy to a hormone therapy–based doublet and which patients would benefit the most from this approach, Wise continues, noting that this question must be evaluated in a clinical trial. He explains that adding chemotherapy to a hormone therapy–based doublet is a clearer decision for patients with high-volume disease who are in a visceral crisis, who have extensive liver metastases, or who have diffused bone metastases with pain. However, a clinical trial is needed to better identify patients with some degree of high-volume disease that is otherwise asymptomatic could benefit from the addition of chemotherapy, Wise notes.