Insight into the expanding landscape of hormone therapies, including androgen receptor inhibitors and biosynthesis inhibitors, and their diverse applications in prostate cancer treatment.
David Morris, MD, FACS: We’re just gonna spend a second here and talk about the advent of these androgen receptor inhibitors [ARIs] and the growth in all the indications for prostate cancer. I think that we recognize that it’s very easy now when we have orally available therapies with survival benefit that…we’re able to push that to the masses much more so than the idea of chemotherapy. Good and bad, chemotherapy is a very charged word, and there are a lot of patients who are unwilling at first blush and first presentation to accept things like chemotherapy. When we mentioned pills and hormone therapy, suddenly we’re much more able to get those into their hands and get them to take it. Adding on top of a hormone therapy that they’ve already been experiencing makes it less of a threat to them.
I think that the landscape with the biosynthesis inhibitors such as abiraterone and the androgen receptor inhibitors has really grown the market for what we can offer these patients because they’re willing to accept those sorts of things. Dr Garmezy, if you could run through some of what’s available and on the market, what’s available for the metastatic hormone sensitive patients, what’s available for the nonmetastatic castration-resistant patients, and obviously the metastatic castration-resistant patients. Those are the oldest data sets that we have because that was where most of the therapies were studied, launched, and they’ve moved earlier and earlier in the process, which means that you’re needing to use your services earlier for these patients, but also more urologists are having these patients in their clinics. They need to be aware of what’s available and what the indications might be for those therapies.
Benjamin Garmezy, MD: I think the more time that passes, the more we realize that the second generation or novel hormonal antagonists are more and more important in the treatment paradigm. We use this concept of ARPI, as the androgen receptor pathway inhibitors, because as mentioned, we have biosynthesis inhibitors, like abiraterone, that we combine with prednisone. We have actual molecules that block the androgen receptors called androgen receptor inhibitors. They work in very different ways, but they have very similar results. We also know that if you’re on one and you switch to the other, oftentimes that resistance to that first agent will lead to resistance to that second agent as well.
In this metastatic castration-sensitive disease, you could use a biosynthesis inhibitor or an androgen receptor inhibitor; both have similar results. We know that it is very important to add that in, because we know that there’s a tangible overall survival benefit to the addition and further blockade of hormones in that disease state. Each trial set up a little different patient population. I think doing the cross-trial comparison probably is more harmful than helpful. I think the key here for anyone listening is that we really do need to intensify this treatment. You have multiple options. You have multiple ARIs or abiraterone, which is a biosynthesis inhibitor that you can use. You can use enzalutamide, apalutamide, abiraterone; all are very reasonable choices, right?
Transcript is AI-generated and edited for readability.