David F. Penson, MD, MPH, MMHC, chair, Department of Urology, and Paul V. Hamilton, MD and Virginia E. Howd Chair, Urologic Oncology, at Vanderbilt University Medical Center, discusses ongoing research in prostate cancer.

Multiple clinical trials are ongoing in prostate cancer currently, says Penson.

For example, the multicenter TRoMbone study is a feasibility trial that is investigating the role of radical prostatectomy in men with oligometastatic disease that has spread to the bone. Additionally, the STAMPEDE trial is planning to open a surgical arm for patients with oligometastatic disease, pending additional funding. 

Other clinical trials are exploring the role of checkpoint inhibitors in prostate cancer, explains Penson.

As novel agents and therapeutic modalities continue to be identified, the field of prostate cancer is moving toward becoming a chronic disease and the potential for cure, concludes Penson.

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David F. Penson, MD, MPH, MMHC, discusses ongoing research in prostate cancer.

Dr. Penson on Ongoing Research in Prostate Cancer

David F. Penson, MD, MPH, MMHC, chair, Department of Urology, and Paul V. Hamilton, MD and Virginia E. Howd Chair, Urologic Oncology, at Vanderbilt University Medical Center, discusses the importance of maintaining quality of life (QoL) for patients treated with androgen-receptor inhibitors in nonmetastatic castration-resistant prostate cancer (CRPC).

In 2018, enzalutamide (Xtandi) and apalutamide (Erleada) were FDA approved for the treatment of men with nonmetastatic CRPC. Darolutamide (Nubeqa) received approval for the same patient population in July 2019.

Though these agents appear to be [similar in efficacy], toxicity differences may guide treatment selection, explains Penson.

For example, enzalutamide is associated with fatigue while apalutamide may cause a rash, says Penson. Patients who experience these adverse events may switch to another agent.

Once the optimal drug is identified, the patient’s QoL will improve and their response will likely be better than if they received androgen deprivation therapy alone, concludes Penson.

David F. Penson, MD, MPH, MMHC, discusses the importance of maintaining quality of life for patients treated with androgen receptor inhibitors in nonmetastatic castration-resistant prostate cancer.

Dr. Penson on Maintaining QoL With AR Inhibitors in Nonmetastatic CRPC

David F. Penson, MD, MPH, MMHC, chair, Department of Urology, and Paul V. Hamilton, MD and Virginia E. Howd Chair, Urologic Oncology, at Vanderbilt University Medical Center, discusses questions regarding next-generation androgen receptor (AR) inhibitors in prostate cancer.

Questions regarding the use of AR inhibitors extend beyond the metastatic setting, says Penson. For example, does a patient with low volume oligometastatic disease need local therapy in addition to a next-generation AR inhibitor? Preliminary data suggest that local therapy may help improve patient outcomes, says Penson. 

In the localized setting, should next-generation AR inhibitors be used in the neoadjuvant or adjuvant settings? Historically, neoadjuvant hormone therapy wouldn’t have been considered prior to local therapy, says Penson. Now, investigators believe that the newer agents could be beneficial as neoadjuvant therapy. This will be the subject of further exploration in the coming years, adds Penson.

Because many of the AR inhibitors have the same mechanism of action, investigational strategies should seek to define combinations that target different pathways, concludes Penson.

David F. Penson, MD, MPH, MMHC, discusses questions regarding next-generation androgen receptor (AR) inhibitors in prostate cancer.

Dr. Penson on Questions Regarding Next-Generation AR Inhibitors in Prostate Cancer

David F. Penson, MD, MPH, MMHC, chair, Department of Urology, and Paul V. Hamilton, MD and Virginia E. Howd Chair, Urologic Oncology, at Vanderbilt University Medical Center, discusses treatment selection in patients with metastatic hormone-sensitive prostate cancer.

Several FDA-approved agents are indicated for patients with mHSPC, including apalutamide (Erleada), abiraterone acetate (Zytiga), and docetaxel. Notably, the FDA granted a priority review designation to a supplemental new drug application for enzalutamide (Xtandi) for the treatment of patients with metastatic hormone-sensitive disease, based on data from the phase III ARCHES and ENZAMET trials.

Given the number of agents that are available in this setting, treatment can be individualized to each patient. For example, patients who have epilepsy would not do well on enzalutamide, says Penson. If the patient is a frail diabetic, they may not do well on abiraterone or docetaxel. If a patient has a high volume of disease, they may respond better to docetaxel over one of the androgen receptor—signaling inhibitors, adds Penson.

David F. Penson, MD, MPH, MMHC, discusses treatment selection in patients with metastatic hormone-sensitive prostate cancer.

David F. Penson, MD, MPH, MMHC

Articles

Dr. Penson on Ongoing Research in Prostate Cancer

Dr. Penson on Maintaining QoL With AR Inhibitors in Nonmetastatic CRPC

Dr. Penson on Questions Regarding Next-Generation AR Inhibitors in Prostate Cancer

Dr. Penson on Treatment Selection in Metastatic Hormone-Sensitive Prostate Cancer