Metastatic Hormone-Sensitive Prostate Cancer (mHSPC): Advances and Treatment Strategies in the First-Line Setting

Abstract

The treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC) has changed radically in recent years. Androgen deprivation therapy (ADT) alone was for decades the standard of care for treating mHSPC. This changed when studies showed that the addition of docetaxel chemotherapy or abiraterone acetate to ADT significantly increases overall survival of patients with mHSPC, followed by more recent evidence showing the efficacy of androgen receptor antagonists, such as enzalutamide and apalutamide, in this setting. While this rapid therapeutic evolution is welcome, it presents clinicians with a crucial challenge: the choice of treatment selection and sequencing. In the first-line setting there are no comparative data currently available to guide treatment choice between the different available regimens, and no prospective data to guide clinical decision after progression. Decisions on treatment will now need to be personalised based on indirect comparison of the available efficacy data from multiple phase 3 studies, together with considerations of disease volume, comorbidities, treatment aims, toxicity profile and cost reimbursement within the healthcare setting. Here, we provide an overview of the clinical trial data to date and propose some biological and clinical insights which may be helpful in making decisions on treatment selection and sequencing.

Living with Advanced Hormone-Sensitive Prostate Cancer and Treatment with Abiraterone and Androgen Deprivation Therapy: The Patient, Nursing and Physician Perspective

“…We have previously examined the relative efficacy of these four agents in a narrative review [13]. As of September 2020, there are no direct comparative trials between these agents, although most oncologists would agree that the efficacy data of the three novel anti-androgens and docetaxel chemotherapy are broadly comparable.…”

Natural Compounds in Sex Hormone-Dependent Cancers: The Role of Triterpenes as Therapeutic Agents

“…Based on the identified hormone-related tumor growth, the first treatments consisted in androgen-deprivation therapy. Currently, the therapeutical options have evolved by associating chemotherapy, radiotherapy and immunotherapy, depending on the tumor, patient or drug side effects (12)(13)(14). The challenges encountered by the endocrine therapy in prostate cancer are depicted in Figure 3; one important finding is that a Western diet rich in long chain fatty acids may promote prostate cancer to lethal stages (15).…”

A real‐world comparison of docetaxel versus abiraterone acetate for metastatic hormone‐sensitive prostate cancer

“…Since androgen deprivation therapy (ADT) remains the backbone of the systemic treatment of mHSPC, combining it either with docetaxel (D) or novel secondary hormonal therapy (SHT) yielded remarkable survival improvement and revolutionized standard care in the clinical routine. 1 In this context, D was the first to achieve a significant reduction of the risk of death by 28% in the long‐term follow‐up of the CHAARTED trial. 2 Due to conflicting results from the CHAARTED and STAMPEDE (arm C) trials, there is still no consensus if it should be used for males with low‐volume and/or recurrent disease.…”