Guideline updated for initial management of advanced prostate cancer

For patients with noncastrate advanced prostate cancer, docetaxel, abiraterone, enzalutamide, apalutamide, or darolutamide are each recommended as standards of care with androgen deprivation therapy (ADT), and doublet therapy is inferior to triplet therapy, according to a guideline update published online April 3 in the Journal of Clinical Oncology.

Katherine S. Virgo, Ph.D., from the Rollins School of Public Health at Emory University in Atlanta, and colleagues developed updated recommendations for initial management of noncastrate advanced, recurrent, or metastatic prostate cancer.

The authors note that each of docetaxel, abiraterone, enzalutamide, apalutamide, or darolutamide, administered with ADT, represent five separate standards of care for noncastrate metastatic prostate cancer. There are no recommendations for the use of any of these agents in any other combination or in any other series, apart from the triplet therapies of docetaxel plus abiraterone plus ADT and docetaxel plus darolutamide plus ADT. Docetaxel plus ADT should be offered to patients with metastatic noncastrate prostate cancer with high-volume disease (four or more bone metastases, one or more of which is outside of the spine or pelvis, and/or the presence of any visceral disease) who are candidates for chemotherapy but are unwilling or unable to receive triplet therapy. Triplet therapy should be offered to patients with de novo metastatic noncastrate prostate cancer with high-volume disease who are being offered ADT plus docetaxel chemotherapy, with significant overall survival and radiographic progression-free survival benefits.

“Patients should be made aware that doublet therapy (docetaxel plus ADT) has proven inferior overall survival compared to triplet therapy, such as abiraterone and prednisone plus docetaxel plus ADT,” the authors write.

One author disclosed employment with NantHealth.

More information:
Abstract/Full Text Katherine S. Virgo et al, Initial Management of Noncastrate Advanced, Recurrent, or Metastatic Prostate Cancer: ASCO Guideline Update, Journal of Clinical Oncology (2023). DOI: 10.1200/JCO.23.00155

Journal information:
Journal of Clinical Oncology

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