Timing of androgen deprivation monotherapy and combined treatments in castration-sensitive and castration-resistant prostate cancer: a narrative review

Systemic treatment options for metastatic hormone-sensitive prostate cancer: making sense of the data

PURPOSE OF REVIEW

Systemic treatment options for metastatic hormone-sensitive prostate cancer (mHSPC) have recently shifted from the traditional androgen deprivation therapy (ADT) monotherapy to multidrug approaches incorporating drugs initially approved for castration-resistant state and ADT. However, clinicians have difficulties in choosing the adequate combination therapy for individualized patient care, because of the lack of consensus regarding disease risk factors, differences in study design of the major clinical trials and lack of direct comparisons between drugs. The aim of this review is to provide an update of the current treatment options for this heterogenous group of patients.

RECENT FINDINGS

Current oncological guidelines strongly recommend that patients with newly diagnosed mHSPC and high-volume disease (CHAARTED criteria) should receive docetaxel and ADT, whereas those with high-risk disease (LATITUDE criteria) abiraterone and ADT. Recently, the Food and Drug Administration approved apalutamide and enzalutamide for mHSPC. Moreover, new data support the efficacy of docetaxel and abiraterone in patients with mHSPC, regardless of metastatic burden.

SUMMARY

Today, the combination approach should be recommended for newly diagnosed mHSPC over ADT monotherapy, but treatment initiation must be personalized based on disease, drug and patient characteristics. Thanks to continuous efforts and progress in patient and disease-related outcomes, mHSPC could become a chronic disease.

Navigating systemic therapy for metastatic castration-naïve prostate cancer

INTRODUCTION

The last decade has seen a remarkable shift in the treatment landscape of advanced prostate cancer, none more so than in the management of metastatic castration-naïve disease.

METHODS

This narrative review will examine existing and emerging evidence supporting systemic therapy use for metastatic castration-naïve prostate cancer (mCNPC) and provide guidance on the selection of these agents with respect to optimising patient outcomes.

RESULTS

The addition of either docetaxel (chemohormonal approach) or an AR pathway inhibitor (abiraterone, enzalutamide or apalutamide) is a reasonable standard of care option for men commencing long-term ADT for mCNPC. While the issue of disease volume as a predictive biomarker for docetaxel benefit has previously been debated, recent data support consideration of upfront docetaxel in all patients, regardless of metastatic burden. Decisions regarding systemic treatment for men with mCNPC should be based on comprehensive consideration of disease, patient and logistical factors. Multiple novel therapeutics for mCNPC are currently under active investigation.

CONCLUSION

The introduction of potent systemic therapy earlier in the mCNPC disease course has resulted in dramatic improvements in clinical outcomes for patients. As the management of mCNPC continues to evolve, the future remains promising, with the expectation of ongoing improvements to patient outcomes and quality of life.