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The Latest Research on mHSPC
Enough is No Longer Enough
The treatment landscape for metastatic hormone-sensitive prostate cancer (mHSPC) has become increasingly complex during the last several years. Since 2014 we have been aware that combination treatment with androgen deprivation therapy (ADT) and docetaxel chemotherapy is associated with improved overall survival in patients with mHSPC. Quality of life (QOL) data suggested that better control of the disease with intensified treatment was associated with similar QOL by 12 months after starting chemohormonal treatment. However, there remained a need to ensure that patients who were not candidates for chemotherapy, or who might not benefit sufficiently from chemotherapy, had an option to improve outcomes.
Alicia Morgans, MD, MPH Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts. She is a clinician and physician investigator specializing in investigating complications of systemic therapy for prostate cancer survivors. She has expertise in clinical trials and patient-reported outcome measures, and as well as incorporating patient preferences and beliefs into clinical decision making.
Since 2015, multiple combination treatment strategies have emerged for the management of patients with metastatic hormone sensitive prostate cancer (mHSPC). The addition of docetaxel and/or androgen receptor-axis targeted (ARAT) agents to standard androgen deprivation therapy (ADT), in the form of doublet and triplet treatment strategies, has demonstrated overall survival benefits in this cohort of patients. As such, these drug combinations have changed the standard of care approaches in these men.1
Read MoreProstate cancer, while commonly diagnosed early in the disease state, remains the second leading cause of cancer mortality in the United States and Europe1 . Of the 1.3 million new annual diagnoses of prostate cancer, 6% of men have metastases at the time of diagnosis. Such patients are defined as having de novo or synchronous metastatic hormone sensitive prostate cancer (mHSPC).
Read MoreThe treatment landscape of metastatic hormone sensitive prostate cancer (mHSPC) has evolved rapidly since the introduction of combination chemohormonal therapy with docetaxel and androgen deprivation therapy (ADT) in 2015.1
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The 2022 ASCO annual meeting featured an oral abstract session on prostate cancer, including a presentation by Dr. Ian Davis discussing updated overall survival outcomes in ENZAMET (ANZUP 1304), an international, cooperative group trial of enzalutamide in mHSPC. Dr. Davis started by highlighting several points regarding the current mHSPC clinical knowledge. First, prognostic variables associated with better outcomes with testosterone suppression alone include (i) low volume being better than high volume disease, and (ii) metachronous metastatic presentation is better than synchronous. Second, the OS benefit of combination treatment by prognostic groups:
Read MoreDarolutamide is a related, but structurally distinct, androgen receptor inhibitor which has demonstrated improved metastasis-free survival and overall survival in patients with nonmetastatic castration-resistant prostate cancer (CRPC). In an oral abstract presentation Dr. Smith presented the first results of the ARASENS trial which examined darolutamide in combination with docetaxel and ADT compared to docetaxel and ADT.
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