Celestia Higano, MD
Clinical trial results that challenge the standard of care sometimes make it more difficult for physicians to decide how to treat their patients. Such is the case with the CHAARTED, LATITUDE, and STAMPEDE trials1-3
, which provided clarity on the value of docetaxel (Taxotere) or abiraterone acetate (Zytiga) in combination with androgen deprivation therapy (ADT) in prostate cancer. However, data from these trials demonstrate the heterogeneous nature of prostate cancer and its subtypes, highlighting the importance of a more cautious approach in choosing therapies for patients with metastatic hormone-sensitive prostate cancer (mHSPC). Disease characteristics, comorbidities, treatmentrelated toxicities, and patient preferences all deserve heightened consideration, according to Celestia S. Higano, MD.
Table 1. Clinically Significant Toxicities for Consideration in Treatment Decision Making for mHSPC
In arm G of the STAMPEDE trial, which studied ADT with or without abiraterone acetate, there was an OS benefit adding abiraterone for all patients because the investigators did not stratify patients by disease volume, Higano said, and they looked at patients with N1M0 disease. However, she noted that there was excellent prostate-specific antigen (PSA) control over 3 to 5 years. In a meta-analysis of patients with low-volume disease in the CHAARTED and GETUG-AFU15 studies, there was no OS benefit for adding either docetaxel or abiraterone acetate.6
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