Dr. Dorff on Choosing Between Therapies in Nonmetastatic CRPC

Tanya B. Dorff, MD, associate clinical professor, Department of Medical Oncology and Therapeutics Research, head, Genitourinary Cancers Program, City of Hope, discusses choosing between therapies in nonmetastatic castration-resistant prostate cancer (CRPC).

Last year brought 2 new agents into this treatment paradigm, said Dorff: apalutamide (Erleada) and enzalutamide (Xtandi). These drugs have not yet been compared head-to-head, so although they are both acceptable options, it is currently up to the physician and patient to decide which option is the right one for each case. Although there are slight differences in their side effect profile, says Dorff, there is no substantial reason for choosing one over the other.

These agents are effective in prolonging survival, but another important endpoint is maintaining quality of life, she adds. Bone fractures are a common adverse event associated with these treatment options, so additional bone therapy is something that needs to be strongly considered.

In February 2018, apalutamide became the first drug to be approved by the FDA for use in patients with nonmetastatic CRPC, following the positive results from the phase III SPARTAN trial. This study showed a 72% decrease in the risk of metastases or death with apalutamide versus placebo. Based on the phase III PROSPER study, enzalutamide followed suit in July 2018, when the data showed a metastasis-free survival of 36.6 months with the agent when used in combination with androgen deprivation therapy.