Evaluating Which Patients With Prostate Cancer Will Benefit From Triplet Therapy

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Not all patients will want to take triplet therapy, but those with high-volume prostate cancer who are chemotherapy eligible are usually a good fit, explained Neal D. Shore, MD, FACS.

For patients with metastatic hormone-sensitive prostate cancer, recent research has shown that triplet therapy has a benefit over doublet therapy.

Both the PEACE-1 and ARASENS trials have combined classic testosterone suppression, androgen-deprivation therapy, with an androgen receptor pathway inhibitor and have shown a benefit in progression-free and overall survival in these patients, explained Neal D. Shore, MD, FACS, medical director of the Carolina Urologic Research Center. In PEACE-1, patients received abiraterone acetate with prednisone plus docetaxel, and in ARASENS, patients received darolutamide with docetaxel.^1,2

The addition of docetaxel means a multidisciplinary team is important, he added. Many urologists won’t give docetaxel and will send the patient to a medical oncologist. He discussed the benefits of triplet therapy at the American Urological Association annual meeting.

At the Advanced Prostate Cancer Consensus Conference, there were discussions around who benefits from triplet therapies, Shore said. From his own perspective, the patients who are a good fit will be fit for chemotherapy, with good metabolic parameters and no neuropathy issues. But more importantly, patients have to want to take proactive measures.

“There may be some patients who just don't want to deal with the added adverse reaction profile, and I respect that,” he said. But certain patients with visceral metastases, a significant amount of bone disease, who may have symptomatic discomfort, and who have liver metastases are high on Shore’s list to prioritize for triplet therapy.

References

1. Fizazi K, Foulon S, Carles J, et al; PEACE-1 investigators. Abiraterone plus prednisone added to androgen deprivation therapy and docetaxel in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2 × 2 factorial design. Lancet. 2022;399(10336):1695-1707. doi:10.1016/S0140-6736(22)00367-1

2. Smith MR, Hussain M, Saad F, et al; ARASENS trial investigators. Darolutamide and survival in metastatic, hormone-sensitive prostate cancer. N Engl J Med. 2022;386(12):1132-1142. doi:10.1056/NEJMoa2119115