The following is a summary of “Early Treatment Intensification in Metastatic Hormone-Sensitive Prostate Cancer,” published in the July 2023 issue of Oncology by Wala, et al.
For generations, oncologists and urologists have relied on androgen deprivation therapy (ADT) to treat metastatic hormone-sensitive prostate cancer (mHSPC). Initially, ADT monotherapy was the standard approach. However, recent trials have demonstrated that a more aggressive upfront strategy can improve outcomes.
Intensification therapy with a doublet regimen, combining ADT with either docetaxel or second-generation oral androgen-receptor pathway inhibitors (ARPIs), has shown significant survival advantages compared to ADT alone. Notably, two trials conducted in 2022, namely PEACE-1 and ARASENS, investigated the potential of triplet therapy by adding an ARPI to the ADT-docetaxel doublet. In the accompanying Original Report, the researchers presented a post hoc analysis of the ARASENS trial, focusing on identifying specific patient subpopulations with mHSPC who may benefit most from triplet therapy.
By categorizing the ARASENS cohort based on disease volume and risk profile, they found that triplet therapy was associated with improved outcomes across all categories, although statistical power was limited in the low-volume cohort. Simultaneously, ongoing trials are exploring the role of radiotherapy (RT) in mHSPC, a treatment modality previously reserved for localized disease or isolated, symptomatic metastases. A case of mHSPC was presented in the study, and they discussed their approach considering the findings of recent studies. They recommend triplet therapy for suitable candidates for chemotherapy, particularly those with high-volume disease. Additionally, when feasible, they advocated for the aggressive use of RT in patients with low-volume mHSPC.