Evan Ya-Wen Yu, MD
The prognosis for patients with castration-sensitive prostate cancer continues to improve, with the recent FDA approval of abiraterone acetate (Zytiga), an agent that has shown promising survival signals. Results from the LATITUDE and STAMPEDE trials have contributed to this dramatic shift, said Evan Ya-Wen Yu, MD.
State of the Science Summit™ on Genitourinary Cancers, Yu, a professor in the Division of Oncology at the University of Washington, and member of the Clinical Research Division at Fred Hutchinson Cancer Research Center, discussed the evolution of treatment for patients with castration-sensitive prostate cancer and how he decides between treatment with abiraterone and docetaxel for this population.
OncLive: Please discuss how treatment has changed for patients with castration-sensitive prostate cancer.
The field has recently changed dramatically after the [results of the] CHAARTED and STAMPEDE trials showed that 6 cycles of docetaxel, when added to standard ADT, led to a dramatic survival benefit for men with newly diagnosed metastatic prostate cancer. There were some patients in the STAMPEDE trial who did not have metastatic disease, but in regard to subsets, we still have to see the long-term benefit. For metastatic disease, it is very cut and dry; there is benefit with docetaxel, especially for those with high-volume disease.
Finally, I spoke about identifying metastases early for patients with biochemical recurrence using next-generation imaging such as prostate-specific membrane antigen-PET to identify early metastases to then do metastases-directed therapy. This is early ongoing research, but it is generating a lot of excitement in the field.
What else would you like to highlight from LATITUDE, CHAARTED, and/or STAMPEDE?
If you look across cancer studies, regardless of the malignancy or agents, it is not uncommon to see a 2-, 3-, 4-, or 5-month median survival benefit. With these agents, we are seeing survival benefits in terms of 1 to 2 years in certain subsets. These are incredibly dramatic and convincing data. There is really no doubt about it.
What other agents are promising other than abiraterone and docetaxel?
There are a lot of studies going on right now that take the same theories—adding chemotherapy earlier. There will be a study coming out looking at cabazitaxel chemotherapy in this setting. There are studies looking at enzalutamide (Xtandi) and apalutamide (Erleada) in this setting, and there are studies that allow combinations of chemotherapy with a second-generation androgen-targeted agent.
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