Novel agents for metastatic hormone‐sensitive prostate cancer – a practice guide for urologists

Thangasamy, Isaac; Kwan, Edmond M.; Teh, Jiasian; Sathianathen, Niranjan; Alghazo, Omar; Azad, Arun; Murphy, Declan

doi:10.1111/bju.14936

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…It is possible that this could lead to lower use of docetaxel in many countries, since relatively few urologists routinely prescribe chemotherapy and they are becoming more comfortable with the use of AR pathway inhibitors in mHSPC. 19 However, oncology multidisciplinary team (MDT) meetings are now widely prevalent in the public and private hospital systems in Australia, providing a valuable channel for facilitating cross referrals to other specialties. Notably, a previous Australian study found that cross-disciplinary referrals at MDT meetings occurred in 26% of prostate patients.…”

Section: Discussionmentioning

confidence: 99%

“…For many decades, urologists have managed mHSPC patients from diagnosis and initiation of ADT, through to the development of mCRPC. It is possible that this could lead to lower use of docetaxel in many countries, since relatively few urologists routinely prescribe chemotherapy and they are becoming more comfortable with the use of AR pathway inhibitors in mHSPC 19 . However, oncology multidisciplinary team (MDT) meetings are now widely prevalent in the public and private hospital systems in Australia, providing a valuable channel for facilitating cross referrals to other specialties.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of real‐world utilisation of docetaxel combined with androgen deprivation therapy in metastatic hormone‐sensitive prostate cancer

Azad

Davis

Parente

et al. 2022

Internal Medicine Journal

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Background Docetaxel has emerged as a standard‐of‐care for metastatic hormone‐sensitive prostate cancer (mHSPC). Uptake of docetaxel for mHSPC in Australia has not previously been reported. Aims To investigate the real‐world uptake of docetaxel in mHSPC and to identify predictors of utilisation of docetaxel in mHSPC. Methods Men diagnosed from June 2014 to December 2018 and enrolled in the Prostate Cancer Outcomes Registry‐Victoria (PCOR‐Vic) were included. Data collected include demographics, diagnosis method and institution, staging investigations and treatments within 12 months of diagnosis. Wilcoxon rank‐sum, Chi‐squared and trend tests were used to identify predictors of docetaxel utilisation. All predictors were entered as covariates simultaneously into a multivariable logistic regression model. Statistical significance was set at 0.05 (two sided). Results In all, 1014 men with mHSPC were analysed, 25% of whom received docetaxel with androgen deprivation therapy. Uptake of docetaxel increased from 20% in 2014 to 33% in 2018. Predictors of higher usage of docetaxel were younger age and treatment in a private hospital, with both remaining significant on multivariable analysis. Notably, the proportion of men aged <70 years receiving docetaxel increased from 54% in 2014–2015 to 64% in 2016–2018, while in men aged ≥70 years the comparative figures were 15% and 22% respectively. Conclusions Although docetaxel was not used in the majority of cases, there was a clear increase in docetaxel uptake, especially in younger men following publication of the CHAARTED and STAMPEDE trials. Identifying barriers to real‐world implementation of pivotal clinical trial data is critical to improving outcomes in mHSPC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of real‐world utilisation of docetaxel combined with androgen deprivation therapy in metastatic hormone‐sensitive prostate cancer

Azad

Davis

Parente

et al. 2022

Internal Medicine Journal

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“…Whilst Docetaxel is most often administered by medical oncologists, it is also administered by urologists in some countries, especially in the Asia-Pacific region (2). The increasing role for well tolerated oral ARPIs combined with ADT for mHSPC, also means that urologists can continue to play a key role in the management of mHSPC, provided they are willing to become facile with the safe use and monitoring of these agents (49). Ultimately, these patients are best managed in multidisciplinary teams, taking into account patient and disease factors, as well as access and affordability issues (50).…”

Section: The Role Of the Urologistmentioning

confidence: 99%

Current treatment options for newly diagnosed metastatic hormone-sensitive prostate cancer—a narrative review

et al. 2021

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Prostate cancer continues to be one of the most commonly diagnosed cancers in men globally and a leading cause of male cancer deaths. The landscape of metastatic hormone-sensitive prostate cancer has significantly changed over the past decade. For many years, androgen deprivation therapy alone through surgical or chemical castration was the mainstay of treatment yielding limited 5-year survival rates. New treatment approaches using Docetaxel chemotherapy or androgen receptor pathway inhibitors to intensify upfront systemic therapy have resulted in significantly improved survival rates compared to androgen deprivation therapy alone. Clinicians are now equipped with an arsenal of drugs capable of prolonging life for metastatic hormone-sensitive prostate cancer patients. Furthermore, new treatment modalities are being tested in clinical trials making treatment of metastatic hormone-sensitive prostate cancer an extremely dynamic space. In this narrative review, we provide an overview of the key systemic treatments for metastatic hormone-sensitive prostate cancer, namely androgen deprivation therapy, novel androgen receptor pathway inhibitors and Docetaxel. We summarise a series of landmark trials that have led to the integration of novel androgen receptor pathway inhibitors and docetaxel into the treatment paradigm for metastatic hormonesensitive prostate cancer. Lastly, we discuss nursing, financial and side-effect considerations pertaining to the use of these drugs. This article aims to give its readers an understanding of the evidence and clinical aspects of novel therapies in metastatic hormone-sensitive prostate cancer as they become increasingly available for use around the world.

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“…With early data suggesting that PSMA‐based RLT may prolong life expectancy more than rival therapeutic strategies, much discussion has been held about its position in the paradigm of advanced prostate cancer and even whether patient outcomes may benefit from the use of RLT at an earlier stage, perhaps in earlier mCRPC prior to hormone therapies or chemotherapy, or even in metastatic hormone‐sensitive prostate cancer (mHSPC). There is now substantial evidence of the benefit of numerous combination approaches in mHSPC [72,73], and it is certainly worth exploring the value of using RLT earlier in the prostate cancer landscape. A clinical trial from Radboud University (NCT03828838) has begun recruiting subjects with low‐volume disease not yet in the CRPC state.…”

Section: Future Directions For Psma Theranosticsmentioning

confidence: 99%

Prostate‐specific membrane antigen theranostics in advanced prostate cancer: an evolving option

et al. 2020

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To review current data for the role of prostate specific membrane antigen (PSMA) radioligand therapy (RLT) for patients with advanced prostate cancer. This review provides an update for multidisciplinary teams on the current and potential future applications of theranostics in prostate cancer. Methods Narrative review focussing on PSMA as a target for RLT, and data using Results RLT with PSMA is an exciting therapeutic alternative to the existing management options already in use for patients with metastatic castrate-resistant prostate cancer (mCRPC). To date, most evidence exists regarding small-molecule PSMA inhibitors bound to beta-emitting radioisotopes such as 177Lu (Lu-PSMA). Prospective phase II data supports the safety and efficacy of Lu-PSMA in men with heavily pre-treated progressive mCRPC, and several late-phase randomised trials of Lu-PSMA are underway, with many more in the pipeline. Early results are encouraging, indicating that the theranostic approach may play a vital role in management of advanced prostate cancer and perhaps even in much earlier disease states. Conclusions PSMA RLT is a promising new treatment option for men with mCPRC, and may also have utility in less advanced prostate cancer.

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Novel agents for metastatic hormone‐sensitive prostate cancer – a practice guide for urologists

Cited by 6 publications

References 7 publications

Predictors of real‐world utilisation of docetaxel combined with androgen deprivation therapy in metastatic hormone‐sensitive prostate cancer

Predictors of real‐world utilisation of docetaxel combined with androgen deprivation therapy in metastatic hormone‐sensitive prostate cancer

Current treatment options for newly diagnosed metastatic hormone-sensitive prostate cancer—a narrative review

Prostate‐specific membrane antigen theranostics in advanced prostate cancer: an evolving option

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