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PEER-TO-PEER CLINICAL CONVERSATIONS
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ARASEC Design and Sensitivity Analyses of Darolutamide plus ADT in Metastatic Hormone-Sensitive Prostate Cancer
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Rana McKay, MD
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| Rana McKay presents ARASEC, a phase 2 open-label study comparing darolutamide plus ADT against the ADT monotherapy arm from CHAARTED using propensity score matching.
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Implementation of the PC360 Algorithm to Manage Cardiovascular and Bone Health Risks on ADT
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Jason Hafron, MD, CMO
Jason Hafron describes the PC360 prostate cancer working group and its implementation covering a 300-patient pilot to coordinate ADT side-effect monitoring across specialties.
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ADT Class and Cardiovascular Risk: A Large Retrospective Analysis in Prostate Cancer
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Andrew Hahn, MD
Andrew Hahn discusses cardiovascular outcomes in prostate cancer, from a real-world analysis from commercial and Medicare databases enrolling approximately 17,000 patients.
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| PSA Outcomes of Darolutamide and ADT in Patient Subgroups by Age, Comorbidities, and Concomitant Medications: ARANOTE Post Hoc Analysis
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| Fred Saad, MD, FRCS, CQ, FCAHS
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| In this ARANOTE post hoc analysis, darolutamide plus ADT improved PSA response rates versus placebo plus ADT across age groups, comorbidity burdens, and concomitant medication strata in men with mHSPC. The findings support consideration of clinical factors such as cardiovascular and metabolic disorders, age, and concomitant medication use when evaluating treatment options.
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| Major Adverse Cardiovascular Events in ARPI-Treated Patients with mCSPC
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| Linden Huhmann
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| In this VA mCSPC cohort, darolutamide was associated with lower observed 1-year major adverse cardiovascular event rates than abiraterone, particularly among patients receiving doublet therapy. The triplet analysis showed a similar but non-significant trend, underscoring the importance of cardiovascular risk assessment when selecting ARPI-based treatment.
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| Classification Tree Phenotypes for Early Treatment-Limiting Toxicity After ARPI Initiation in mHSPC from the IRONMAN Registry
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| Alexandra Larkin, MPH
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| A simple classification tree from the IRONMAN registry identified mHSPC patients at very different risks of early ARPI toxicity or treatment discontinuation within 1 year. High-risk phenotypes were linked to worse baseline health, symptomatic disease, anemia, elevated LDH, and more intensive treatment, while low-risk patients had a much lower adverse outcome rate.
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| Potential for Drug-Drug Interactions with Novel ARTAs and Concomitant Medications: Analysis Based on the Metastatic Hormone-Sensitive Prostate Cancer Patients in the Real-World Evidence RECOMMEND Study
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| Amit Bahl, MBBS, FRCR
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| This real-world mHSPC analysis evaluated the potential for drug-drug interactions with novel androgen receptor-targeted agents in patients receiving concomitant medications. The findings reinforce the importance of reviewing polypharmacy and potential interaction risk when selecting an ARPI for patients with mHSPC.
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| Efficacy and Safety of Enzalutamide in Patients with mHSPC and Cardiometabolic Comorbidities And/or Related Concomitant Medications: ARCHES Post Hoc
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| Arnulf Stenzl, MD
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| In ARCHES, enzalutamide plus ADT remained highly effective and well tolerated in men with mHSPC who had cardiometabolic comorbidities or were taking related medications. The benefit was consistent for radiographic progression-free survival and overall survival, with no new safety signals, supporting enzalutamide as a standard option in this comorbidity-heavy population.
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| Considerations for Selection of ARPIs in Older Patients with mHSPC
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| Dana Rathkopf, MD
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| Dana Rathkopf emphasized that treatment choice in older mHSPC patients should be driven more by physiologic fitness than age alone, with frailty, comorbidities, cognition, and polypharmacy all factoring into the risk-benefit balance. She noted that ARPI-based therapy still benefits many older patients, but drug-specific toxicities matter: abiraterone can worsen metabolic and steroid-related issues, enzalutamide/apalutamide raise fall and CNS risk, and darolutamide may be better tolerated in fit older men, especially when triplet therapy is being considered.
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