WHICH PATIENTS WILL BENEFIT MOST FROM DOCETAXEL ADDITION TO ANDROGEN DEPRIVATION THERAPY (ADT) IN METASTATIC CASTRATE-SENSITIVE PROSTATE CANCER (MCSPC)?

Abstract

Docetaxel improved the outcome of patients with mCSPC and became standard of care after CHAARTED, STAMPEDE arm C and GETUG-AFU 15 clinical trials and after subsequent meta-analysis. Patients with high-volume (CHAARTED definition) and high-risk (LATITUDE definition) disease, who have good performance status and are fit for chemotherapy, seem to benefit the most from addition of docetaxel to the androgen deprivation therapy. Results from TITAN trial with apalutamide showed the activity in the same setting. However, predictive biomarkers are still lacking. We have direct evidence of overall survival benefit from abiraterone, apalutamide and enzalutamide for patients with high-volume disease who are not fit for chemotherapy, as well as for patients with low-volume disease. Clinical trials will show is there place for triple therapy in clinical practice. Before obtaining the results of new clinical trial results, physicians should base their treatment decision on risks and benefits of each current approach and consider the patient´s other health issues such as access, costs, patient and patient´s preferences.

Keywords: Androgen-receptor Inhibitors; Docetaxel; High-risk; High-volume; Hormone-sensitive; Prostate Cancer.