Tanya Dorff, MD
Two critical clinical trials—SPARTAN and PROSPER—served as the basis for the 2018 FDA approvals of apalutamide (Erleada) and enzalutamide (Xtandi), respectively, agents that have drastically changed the standard of care for patients with nonmetastatic castration-resistant prostate cancer (CRPC), said Tanya B. Dorff, MD.
during the meeting, Dorff, associate clinical professor in the Department of Medical Oncology and Therapeutics Research, and head of the genitourinary cancers program at City of Hope, discussed landmark approvals in nonmetastatic CRPC and anticipated developments in metastatic CRPC.
OncLive®: What trials have defined the field of nonmetastatic CRPC?
: For nonmetastatic CRPC, there were 2 landmark studies that have now changed the way we practice. First and foremost, it's important to image patients whose prostate-specific antigen (PSA) is rising despite castration therapy, so that we can correctly categorize them as metastatic or nonmetastatic––even oligometastatic versus large-volume metastatic disease. When we do find patients who are truly nonmetastatic castration-resistant, but we can't find anything on conventional imaging, we need to check their doubling time to categorize them as high-risk or not. We use a PSA doubling time cutoff of £10 months. That's what was used in both of the trials.
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