COMMENTARY

New Data Change Metastatic Prostate Cancer Treatment Paradigm

Gerald Chodak, MD

Disclosures

August 14, 2017

Hello. I am Dr Gerald Chodak for Medscape. Today's topic is the management of newly diagnosed metastatic prostate cancer.

At the 2017 annual meeting of the American Society of Clinical Oncology, Fizazi and colleagues[1] presented data from the LATITUDE study. In this trial, 1200 men were randomly assigned to receive androgen deprivation therapy (ADT) alone or in combination with abiraterone acetate plus prednisone. To meet enrollment criteria, participants had to have two of the three following high-risk characteristics: a Gleason score of 8 or above, at least three bone metastases, or at least three visceral metastases.

The results of this phase 3 study have matured to the point of allowing an assessment of overall survival. Thus far, the median survival has not yet been reached in the combination therapy arm, but it was 37 months in the patients who received ADT alone, and this was a statistically significant difference. There was also a statistically significant better outcome in time to disease progression and appearance of new disease in the combination-therapy group.

What does this mean going forward? Yet again, this represents a possible paradigm shift in the treatment of metastatic prostate cancer, because these data show that adding early use of abiraterone acetate with prednisone to ADT can help patients. It does present an interesting question, however. We know from a previous trial[2] that chemotherapy used earlier in combination with ADT also significantly improves survival. Thus, what do we do now? Should men with newly diagnosed metastatic disease receive ADT combined with docetaxel or abiraterone acetate plus prednisone?

Both have potential side effects. In this recent randomized trial, there was a significantly higher incidence of hypertension, low potassium levels, and worsening liver function. But chemotherapy has a different set of side effects. Going forward, we will hear much debate about which approach may be best. One wonders whether a new randomized trial will be forthcoming in which the two combined therapies are evaluated one against the other. For now, however, a man with newly diagnosed metastatic prostate cancer should be presented both sets of data and, along with his urologist, evaluate which of the two will be the best approach for him.

I look forward to your comments. Thank you.

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