Jingsong Zhang, MD, PhD, interim vice chair, genitourinary oncologist, Department of Genitourinary Oncology, Moffitt Cancer Center, assistant professor of oncology and internal medicine, University of South Florida College of Medicine, discusses the current state of risk stratification in metastatic castration-resistant prostate cancer (mCRPC).

Clinical features, such as site of metastasis, metastasis burden, and prostate-specific antigen (PSA) response, factor into risk stratification for men with mCRPC, Zhang explains. Although PSA response is associated with robust clinical data indicating response to treatment, risk stratification is inconclusive until about 6 to 7 months after treatment initiation.

As such, androgen deprivation therapy (ADT) in combination with chemotherapy represents the current standard frontline therapy for patients with mCRPC who have visceral metastases, liver metastases, or symptomatic bone metastases, Zhang says. Hormonal therapy is often added to this frontline regimen, but some patients face copay challenges that delay adding hormonal therapy by a few weeks.

Asymptomatic patients who are clinically fit could be started on ADT plus a luteinizing hormone–releasing hormone agonist and bicalutamide (Casodex), Zhang explains. If patients derive a significant PSA response, they can be stratified into the good-risk category and could potentially be spared hormonal therapy.

Ultimately, patients with mCRPC cannot be cured of their disease even with ADT, hormonal therapy, and chemotherapy. Additional treatments are needed for patients who progress on up-front therapy and develop resistance to ADT, chemotherapy, or hormonal therapy, Zhang concludes.

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Jingsong Zhang, MD, PhD, discusses the current state of risk stratification in metastatic castration-resistant prostate cancer.



Dr. Zhang on the State of Risk Stratification in mCRPC 

Jingsong Zhang, MD, PhD, discusses the advancements for patients with metastatic castration-resistant prostate cancer (mCRPC) that have occurred over the last decade.

Since 2010, there have been 6 drugs approved for treating stage IV disease when patients no longer respond to hormonal therapy, such as androgen-deprivation therapy (ADT) and leuprolide acetate for depot suspension (Lupron). Five of these agents are based on an improvement of overall survival, Zhang says.

Researchers are investigating how to best sequence these agents and how they may benefit patients in combination. The CHAARTED trial, for example, demonstrated that upfront chemotherapy should be administered when patients start ADT, as it has a survival benefit here.

Regarding tumor markers, there is AR-V7, which is a predictive marker in terms of response to newer androgen-deprivation agents such as abiraterone acetate (Zytiga) and enzalutamide (Xtandi). Ongoing phase III trials are targeting this patient population, but they have positive AR-V7 in their circulating tumor cells.

Jingsong Zhang, MD, PhD

Articles

Dr. Zhang on the State of Risk Stratification in mCRPC

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