Metastatic Castration-Sensitive Prostate Cancer: Evolving Management With New Data from ASCO 2025 - Episode 2
Panelists discuss how medical comorbidities, physiologic vs chronologic age, drug interactions, and performance status influence the choice between doublet and triplet therapy regimens.
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Alicia Morgans, MD, MPH,addresses the crucial role of patient fitness assessment in determining optimal treatment strategies for patients with metastatic castration-sensitive prostate cancer. The distinction between chronological and biological age becomes paramount when selecting between doublet and triplet therapy regimens. Recent data suggest that patients older than 75 years may derive less overall survival benefit from abiraterone-based treatments, although individual patient assessment remains essential for treatment decisions.
Comorbidity management significantly influences therapy selection, particularly concerning cardiovascular disease, diabetes, and conditions that may be exacerbated by fluid retention or steroid use. The availability of 3 different androgen receptor pathway inhibitors (ARPIs) provides flexibility in treatment selection based on patient-specific factors and potential drug interactions. Careful evaluation of concurrent medications becomes increasingly important as patients live longer and develop polypharmacy.
The ongoing Triple Switch trial represents a significant advancement in answering the doublet vs triplet therapy question. This adaptive trial examines whether adding docetaxel to androgen deprivation therapy plus ARPI improves outcomes in patients who do not achieve optimal prostate-specific antigen response. The study design focuses on early treatment response markers to guide therapy intensification, potentially providing crucial evidence for personalized treatment approaches in the near future.