Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017

Abstract

The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.

Current treatment strategies for advanced prostate cancer

“…51 A number of factors potentially predicting the treatment outcome, such as serum lactate dehydrogenase 32,52 and alkaline phosphatase, 53 have been recognized as potential markers for the treatment of APC. In addition, a number of studies including post-hoc analysis have further provided new insights for a higher NLR predicting lower response rate to abiraterone, 54 and a higher dNLR (dNLR = absolute neutrophil count / white blood cells -absolute neutrophil count) predicting shorter OS to docetaxel 55 (post-hoc analysis from VENICE and TAX327 studies), whereas cabazitaxel had a comparable effect on OS in patients with a higher NLR in a post-hoc analysis from TROPIC study.…”

Assessment of the Validity of Nuclear-Localized Androgen Receptor Splice Variant 7 in Circulating Tumor Cells as a Predictive Biomarker for Castration-Resistant Prostate Cancer

“…Prospective randomized trial data comparing them directly are lacking, but based on individual trial data, comparative safety profiles and mode of administration (oral vs. intravenous), ARS inhibitors are the preferred choice at the first-line decision point in the management of mCRPC. 1 However, as response or failure on one ARS inhibitor does not uniformly predict response or non-response to a second, 2–4 there are no formal guidelines on how best to sequence these agents to optimize individual patient outcomes. 5 In routine clinical practice, the majority of mCRPC patients receive a second ARS inhibitor after failing ARS inhibition in the first line, despite the low PSA response rate.…”

The Contemporary Use of Radium-223 in Metastatic Castration-resistant Prostate Cancer

“…42 However, new hormonal agents currently are considered as firstline options in patients with asymptomatic or mildly symptomatic mCRPC. 15,18 Consequently, the treatment sequence for mCRPC has changed, moving docetaxel and radium-223 after abiraterone and/or enzalutamide when these agents are used as first-line treatment. In patients progressing on first-line new hormonal agents (with no evidence of visceral disease), for those whose disease is symptomatic, radium-223 would be an appropriate second-line choice.…”

“…Radium-223 product information, treatment guidelines, and some experienced clinicians do not exclude the use of radium-223 in first-line treatment of some patients with mCRPC and symptomatic bone metastases (no visceral disease). 15,18,35,36,44 Radium-223 may also be considered for some patients (those with good performance status) as third-or fourth-line treatment options. With no supporting level 1 data from clinical trials, the optimal position of radium-223 in the current treatment paradigm is not established, and decisions as to the timing of its use are left largely to the clinical judgment of the treating physician (Figure 2).…”

“…[15][16][17] The optimal patient profile for radium-223, and the best use of the agent either in sequence or in combination with other approved agents is however, unclear, with few expert consensus opinions available. 18,19 This article reports on the views of a group of urologists and medical oncologists from Europe, Israel, and Canada experienced in treating patients with mCRPC in routine clinical practice. The aim is to provide an overview of the current use of radium-223 in the treatment of mCRPC and to discuss best practices for patient selection and on-treatment monitoring.…”