Dr. Oh on Sequencing New Treatments for Prostate Cancer

William K. Oh, MD, Chief of the Division of Hematology and Medical Oncology, the Tisch Cancer Institute at Mount Sinai Medical Center, explains that in the past few years more than six new therapies for treating castration-resistant prostate cancer (CRPC) have been approved and now the challenge facing many physicians is how to optimally sequence these therapies.

The guiding principles for sequencing any therapeutic is to begin with the treatment that is the most effective with the least toxicities. Following this approach, treatments can be further sequenced using the mechanism of action (MOA) as a guide. Oh notes, that each of the newly approved therapies for CRPC seem to represent a unique MOA, including cytotoxic agents, immunotherapies, androgen therapies, radiopharmaceuticals, and others.

As an example, Oh notes that, since these therapies have multiple MOAs, if a patient does not do well on hormonal therapy another option is available that uses a different approach, such as a cytotoxic. Additionally, he adds that immunotherapies should likely be administered in the frontline, when the immune system is at its strongest.