Dr. Morgans discusses first-line therapy options for mCRPC and her approach to deciding between different treatment options.
Alicia Morgans, MD, MPH: The first-line options for treatment of metastatic CRPC [castration-resistant prostate cancer] are numerous, and we make our decisions based on the treatments the patient has had prior, either for nonmetastatic CRPC or for metastatic hormone-sensitive prostate cancer.
For example, patients who have had treatment with intensified ADT [androgen deprivation therapy] for metastatic hormone-sensitive prostate cancer with abiraterone, enzalutamide, or apalutamide should receive a different approach for metastatic CRPC. Usually, it’s going to be a docetaxel chemotherapy and an ADT combination in that first-line setting. If a patient has had docetaxel in the metastatic hormone-sensitive setting, they would typically proceed with a shift in the mechanism of action to treatment with ADT plus abiraterone or enzalutamide.
For patients who have had treatment for nonmetastatic CRPC, we only have those AR [androgen receptor]–targeted agents as options for intensification with our ADT, and those patients typically get treatment with chemotherapy. It’s important to remember that there are other options; for patients who have relatively slowly progressing and asymptomatic disease, sipuleucel-T is an option. For patients who have DRD alterations, they could potentially get treatment with olaparib if they had previous treatment with an AR-targeted treatment combination with ADT. Finally, if patients have significant bone metastases and pain, they could even get treatment with radium.
There are a lot of options, and we make our treatment decisions for first-line metastatic CRPC based on the combinations of therapies the patient has had in the past.
Transcript edited for clarity.
A 70-Year-Old Man with Metastatic Castration-Resistant Prostate Cancer
A 70-year-old man presents with nocturia and decreased appetite