“The benefits can be reaped by the vast majority of patients and because we're really undertreating these patients, we need to make a conscious effort to overcome whatever barriers are facing us,” says Alicia Morgans, MD, MPH.
Dr. Alicia Morgans, MD, MPH, discusses treatment intensification for patients with metastatic hormone-sensitive prostate cancer (mHSPC) noting that adding treatments to standard androgen-deprivation therapy (ADT) has been shown to benefit a large population of patients. For example, although not mentioned in this video, the phase 3 ARASENS trial showed the benefit of treatment intensification with triplet therapy in this setting.
The trial randomized patients with mHSPC to darolutamide or matched placebo plus ADT and docetaxel. Results showed that the darolutamide triplet regimen improved overall survival (OS) versus ADT/docetaxel alone. At a median follow-up of 43.7 months for darolutamide plus ADT/docetaxel and 42.4 months with placebo plus ADT/docetaxel, treatment with the triplet resulted in a 32.5% reduction in the risk of death (HR 0.68; P <.001).1
Morgans is a member, faculty of medicine, Harvard Medical School, and medical director, Survivorship Program, Dana-Farber Cancer Institute.
Although we still use ADT alone as a field in around half of our patients, we know that ADT plus something else, whether it's an androgen receptor signaling inhibitor or maybe triplet therapy with ADT, docetaxel, and abiraterone or darolutamide, can be associated with improved survival and disease control but also with improved and maintained quality of life. This is really an important message that we need to combine ADT with something else, and that the benefits can be reaped by the vast majority of patients and because we're really undertreating these patients, we need to make a conscious effort to overcome whatever barriers are facing us and causing us to undertreat those patients to do better.
The transcript has been edited for clarity.
1. Smith MR, Hussain MHA, Saad F, et al. Darolutamide and survival in metastatic, hormone-sensitive prostate cancer. N Engl J Med. Published online February 17, 2022. doi: 10.1056/NEJMoa2119115