Professional paper
https://doi.org/10.20471/acc.2024.63.s2.14
A New Paradigm in the Systemic Treatment of Advanced Prostate Cancer: the Earlier the Better or the More the Better
Tomislav Omrčen
orcid.org/0000-0002-7656-7877
; Department of Oncology and Radiotherapy, University Hospital Split, Split, Croatia; School of Medicine, University of Split, Split, Croatia
*
Jure Murgić
orcid.org/0000-0001-8152-0494
; Department of Oncology and Nuclear Medicine, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
* Corresponding author.
Abstract
Androgen deprivation therapy (ADT) has been the backbone of treatment for advanced
prostate cancer (APC) for decades. The introduction of docetaxel and androgen receptor pathway
inhibitors (ARPI; abiraterone, enzalutamide, apalutamide) in the treatment of metastatic hormone-
sensitive PC (mHSPC) has changed the treatment landscape of APC. Data from studies with
docetaxel (CHAARTED, STAMPEDE) and NHT (STAMPEDE, LATITUDE, ENZAMET,
ARCHES, TITAN) suggest that ADT monotherapy is no longer acceptable for the treatment of men
with mHSPC. Systemic treatment options in this indication include: doublet therapy consisting of
ADT plus abiraterone (AAP) or apalutamide (APA), or enzalutamide (ENZ); ADT plus docetaxel
remains an option for settings where ARPI is not available or the combination of ADT and docetaxel
with ARPI is not possible, and triple therapy consisting of a combination of ADT, docetaxel, and AAP
or darolutamide (PEACE-1, ARASENS studies), especially for patients with high-risk/high-volume
synchronous disease. More data are needed on the potential combination of ADT with docetaxel and
APA or ENZ. In the decision to treat a patient with mHSPC, in addition to the results of relevant
studies, the general condition of the patient, their comorbidities and co-medication, affinities, availability
and toxicity of drugs, and the cost of treatment should all be taken into account. Finally, further
elucidation of the biology of different groups of mHSPC to identify different clinical behavior may
be helpful in deciding the optimal treatment of these patients. Analysis of transcriptomic biomarkers
of patient samples from large, practice-changing mHSPC studies could optimize patient selection for
different treatment strategies and help physicians make decisions in daily practice.
Keywords
Hormone-sensitive prostate cancer; Docetaxel; Androgen receptor pathway inhibitors; Doublet therapy; Triplet therapy
Hrčak ID:
323265
URI
Publication date:
30.4.2024.
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