Expert discusses triplet regimens in metastatic hormone-sensitive prostate cancer

In this video, Dr Louise Kostos discusses patient subgroups that see the most benefit from triplet regimens incorporating docetaxel in metastatic hormone-sensitive prostate cancer. She is an author of the recent European Urology paper “Combination Therapies in Locally Advanced and Metastatic Hormone-sensitive Prostate Cancer.” Kostos is a medical oncologist and PhD candidate at Peter MacCallum Cancer Centre in Victoria, Australia.

Transcription:

The abstract highlights the shift toward early treatment intensification in mHSPC. Could you elaborate on the specific patient subgroups where you've seen the most significant benefit from triplet regimens incorporating docetaxel, and what key factors should clinicians consider when making these treatment decisions?

The standard now for really all patients with metastatic hormone-sensitive prostate cancer is a doublet with ADT and an ARPI, and that's obviously presuming that an ARPI is available and that the patient is medically suitable to receive one. But in select patients, you can also consider adding 6 cycles of upfront docetaxel as part of a triplet regimen. This is based on data from 3 landmark studies, which were the PEACE-1, ARASENS, and ENZA-MET studies. These 3 studies were all different in terms of the study design and the patient population, which I won't delve into, but essentially, they all compared a triplet regimen with different ARPIs to a control arm of ADT plus docetaxel, and they all found a consistent benefit in patients with synchronous or de novo metastatic hormone-sensitive prostate cancer. On subgroup analysis, it did appear that this benefit was limited in terms of statistical significance to the patients with high-volume disease. I will mention that is high volume based on conventional imaging using the CHAARTED criteria, which is another discussion point, because obviously many patients are having PSMA PET scans now. But in terms of how I select patients, I really look at the timing of metastatic disease, so whether it's metachronous or synchronous and the volume, and I think at this stage, the data are most robust for the synchronous and high-volume patients. It is important to note, though, that, as I mentioned, the comparator arm in these trials is not our current standard. They compared the triplet treatment to ADT plus docetaxel, and most clinicians are now using ADT plus an ARPI. So we actually don't know if adding docetaxel to an ADT plus an ARPI provides extra benefit, but I guess we just have to extrapolate from the data that we have available.

This transcript was AI generated and edited by human editors for clarity.