Dr Bilen on Treatment Selection Considerations in mCSPC

“We have all of these options, and we clearly know that ADT monotherapy is a suboptimal treatment for this patient population. I believe we have to [administer] at least doublet [therapy]. We have a number of doublet options, including apalutamide, enzalutamide, abiraterone and darolutamide. We have 2 triplet options: ADT plus darolutamide and chemotherapy, or ADT plus abiraterone and chemotherapy.”

Mehmet Bilen, MD, director of the GenitourinaryMedical Oncology Program at the Winship Cancer Institute of Emory University and a professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine, discussed treatment selection considerations in patients with metastatic castration-sensitive prostate cancer (mCSPC).

Single-agent treatment with androgen deprivation therapy (ADT) is a suboptimal option for patients with mCSPC and oncologists must at least consider doublet therapy in this patient population, Bilen began. Doublet component options include apalutamide (Erleada), enzalutamide (Xtandi), abiraterone (Zytiga) and darolutamide (Nubeqa), he continued. Bilen added that there are also 2 available triplet regimens: androgen-deprivation therapy (ADT) plus darolutamide and chemotherapy as well as ADT plus abiraterone and chemotherapy.

However, patients often experience anxiety at the prospect of receiving chemotherapy and sometimes patients do not need to receive chemotherapy at all, Bilen explained. Oncologists are then faced with the decision of which doublet option to pursue, he explained.

Findings from a real-world analysis which showed that patients who received apalutamide ADT without docetaxel (n = 1460) achieved a 51% (HR, 0.49; 95% CI, 0.30-0.83; P = .007) reduction in the risk of death compared with those treated with darolutamide plus ADT without docetaxel (n = 287). These data can help oncologists to make a more informed decision about which doublet option may be more beneficial for a given patient, he explained. Additional information from real-world analyses, including the rate of 90% decline in prostate-specific antigen level as well as overall outcomes, could further inform treatment decision-making in this setting, he concluded.