Deborah A. Bradley, MD, oncologist, Levine Cancer Institute, discusses next steps for research in nonmetastatic prostate cancer.
Deborah A. Bradley, MD, oncologist, Levine Cancer Institute, Atrium Health, discusses next steps for research in nonmetastatic prostate cancer.
The SPARTAN and PROSPER trials moved the needle in the right direction for this treatment paradigm, which had remained stagnant for some time. A couple of important unanswered questions that need to be addressed in future research is if apalutamide (Erleada) and enzalutamide (Xtandi) should be combined with other agents and if one agent demonstrates superiority over the other. Bradley says that in her opinion, one is not more effective than the other.
In the SPARTAN trial, there was an exploratory secondary endpoint, which looked at a second disease-free survival. Bradley says the patients who received apalutamide and then moved on to another therapy did better compared with those who received placebo before the next phase of treatment. This brings up the question of when to treat patients—is sooner better?
Additionally, when patients with metastatic castration-resistant prostate cancer switch from an agent like apalutamide to abiraterone acetate (Zytiga), or vice versa, there is no significant benefit. But when patients are treated first in the nonmetastatic setting, they seem to have a better response, Bradley says. Future research is needed to better understand why patients might respond in one situation and not the other.