Dr Wise on the Optimal Use of Treatment Intensification in mHSPC

David R. Wise, MD, PhD, assistant professor, Department of Medicine, Department of Urology, NYU Grossman School of Medicine, director, Genitourinary Medical Oncology, NYU Langone Health’s Perlmutter Cancer Center, NYU Langone Health, discusses changes in the optimal use of intensified treatment regimens in patients with metastatic hormone-sensitive prostate cancer (mHSPC).

Historically, treatment intensification was not considered until after patients with mHSPC experienced disease progression, Wise states. However, improved understanding of disease biology has led to a shift in the recommended use of this strategy. Now, intensified therapy is being utilized earlier in the treatment course in combination with other highly effective frontline therapies, and multiple studies have demonstrated improvements in long-term survival seen with this approach, Wise says.

Accordingly, the intensification of up-front traditional androgen-deprivation therapy (ADT) with the addition of a novel hormonal agent has become a highly effective strategy for improving long-term survival outcomes and delaying disease progression, Wise continues.

Until recently, doublet treatment intensification with the addition of docetaxel or an androgen receptor signaling inhibitor (ARSI) to ADT was considered the standard of care (SOC) in mHSPC.However, data from the phase 3 PEACE-1 (NCT01957436) and ARASENS (NCT02799602) trials have shown substantial benefit with the use of intensified triplet therapy vs doublet therapy in the up-front setting, Wise notes.

The ARASENS study showed that the use of darolutamide (Nubeqa) plus ADT and docetaxel in mHSPC resulted in a 32.5% reduction in the risk of death compared with docetaxel and ADT alone. In the PEACE-1 trial, ADT, docetaxel, and abiraterone acetate (Zytiga), plus prednisone significantly improved overall survival (OS) and radiographic PFS (rPFS) in this population. These trials indicate that triplet therapy may be a new SOC option for some patients with mHSPC, Wise concludes.