Anti-Androgens and Combination Regimens in CRPC

Peter Salgo, MD, and Ira M. Klein, MD, MBA, FACP, discuss heterogeneous tumors in prostate cancer, the utilization of combination regimens, and the need for additional research within the field.

Dr Klein explains that because there is limited information available about the significance of heterogeneity in prostate cancer, the decision to recommend combination therapy over monotherapy is not based on tumor heterogeneity but rather on other patient-specific factors.

Furthermore, he notes that there are currently insufficient data regarding the optimal sequencing of anti-androgens. Although attacking cancer through various methods that target multiple steps in a pathway tends to be more effective, this is not always the case, Dr Klein adds.

Dr Klein comments that a prospective, randomized, controlled trial evaluating the combination of abiraterone and enzalutamide in patients with castration-resistant prostate cancer (CRPC) has not been conducted to date, and suggests that incentives to conduct such trials and improvements in data collection systems are necessary.

With regard to first-line therapy, an ongoing trial is evaluating cabazitaxel versus docetaxel as first-line therapy in combination with prednisone in patients with CRPC. Dr Klein is optimistic that the results of this trial will help clarify the role of cabazitaxel in first-line treatment of CRPC.

Watch our related Peer Exchange, Oncology Stakeholder Summit 2014: Evidence-Based Decisions to Improve Quality and Regulate Costs