Insights into Doublet Therapy and Clinical Trial Takeaways for Metastatic Prostate Cancer Treatment

Fred Saad, CQ, MD, FRCS, FCAHS, discusses how combining therapies like androgen receptor–targeted agents, androgen deprivation therapy, and docetaxel can potentially improve outcomes for metastatic prostate cancer patients, with treatment selection influenced by factors such as disease volume and risk level.

The panelist discusses how incorporating chemotherapy into combination treatments for metastatic prostate cancer presents challenges such as increased resource requirements, the need for interdisciplinary collaboration, and potential inconveniences for patients, including more frequent clinic visits and laboratory monitoring.

Fred Saad, CQ, MD, FRCS, FCAHS, discusses how the inclusion of chemotherapy, particularly docetaxel, in combination therapies for metastatic prostate cancer alters the adverse event profile, noting that while the ARASENS trial found adverse effects to be largely consistent with previous docetaxel studies, they consider whether this aligns with observations in clinical practice.

The panelist discusses how patient characteristics, disease factors, and individual health status guide the decision to include or avoid chemotherapy in combination treatments for metastatic prostate cancer, weighing potential benefits against risks and quality of life considerations.

Fred Saad, CQ, MD, FRCS, FCAHS, discusses how darolutamide offers potential advantages over other androgen receptor–targeted therapies for metastatic prostate cancer, including its unique molecular structure, favorable safety profile, and efficacy in specific clinical scenarios.

The panelist discusses how the ARANOTE trial demonstrated significant benefits of adding darolutamide to androgen deprivation therapy for patients with metastatic hormone-sensitive prostate cancer, showing improvements in radiographic progression-free survival and other key outcomes.

Fred Saad, CQ, MD, FRCS, FCAHS, discusses how the ARANOTE trial results support using darolutamide plus androgen deprivation therapy in a broad range of patients with metastatic hormone-sensitive prostate cancer, offering flexibility in treatment choices by providing an effective non-chemotherapy option that can be tailored to individual patient needs and preferences.

Panelists discuss how combining radium-223 with androgen receptor–targeted therapy like enzalutamide addresses historical challenges in treating metastatic castration-resistant prostate cancer, including poor radium-223 uptake, prostate-specific androgen–level control issues, and the need for multimodal treatment approaches.

Panelists discuss how the PEACE III trial findings demonstrate the superiority of combining radium-223 with enzalutamide in treating metastatic castration-resistant prostate cancer, highlighting improved efficacy, the critical importance of bone-protective agents in reducing fracture risk, and the potential for this triplet therapy to become the new standard of care over enzalutamide alone.

Panelists discuss how PARP inhibitor monotherapy trials like TALAPRO-1 (talazoparib) and TRITON-3 (rucaparib) have demonstrated efficacy and safety in treating metastatic prostate cancer patients with homologous recombination repair gene alterations, providing important insights into targeted therapy options for this specific patient population.

Panelists discuss how the PROfound trial (NCT02987543) demonstrated the efficacy and safety of olaparib monotherapy in metastatic prostate cancer patients with homologous recombination repair gene alterations, highlighting its potential as a targeted treatment option and its impact on the landscape of precision medicine in prostate cancer management.

Panelists discuss how the increased use of androgen receptor–targeted therapy in clinical practice may impact the effectiveness of PARP inhibitor combinations like talazoparib in the TALAPRO-2 study, while also addressing safety concerns, potential differences in trial populations, and the need for future studies to optimize treatment approaches for various metastatic prostate cancer patient subgroups.