MDACC 2018: An Update on the Treatment of M0 CRPC

Houston, TX (UroToday.com) Within the past year the landscape of M0 CRPC has changed dramatically on the heels of 2 studies using early administration of 2nd generation androgen receptor blockers. Both apalutamide and enzalutamide have multiple inhibitor mechanisms for the AR receptor and have been accepted in the metastatic setting.

In separate landmark trials, each drug was able to improve metastasis-free survival (MFS), disease-specific, and overall survival1, 2. On deeper analysis, longer doubling time (>6months) was found to be an important predictor of response to therapy, but even when <6 months a benefit was demonstrable. Dr. Aparacio points out the discordance between the strict definition of M0 and what we observe anecdotally as slightly enlarged lymph nodes that do not meet size criteria for metastasis.

She cautions that not all M0 CRPC patients should be started on therapy at the first sign of PSA elevation since both of the available medications have the potential to cause serious adverse events, including an increased risk of falls that can be catastrophic in an elderly population.


Presented by: Ana Aparicio, MD, Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

Written by Justin T. Matulay, MD, Urologic Oncology Fellow and Ashish M. Kamat, MD (@UroDocAsh), Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 13th Update on the Management of Genitourinary Malignancies, The University of Texas (MDACC - MD Anderson Cancer Center) November 9-10, 2018, Dan L. Duncan Building, Houston, TX

References
1. Smith, M.R., F. Saad, S. Chowdhury, et al., Apalutamide Treatment and Metastasis-free Survival in Prostate Cancer. N Engl J Med, 2018. 378(15): p. 1408-1418.
2. Hussain, M., K. Fizazi, F. Saad, et al., Enzalutamide in Men with Nonmetastatic, Castration-Resistant Prostate Cancer. N Engl J Med, 2018. 378(26): p. 2465-2474.
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