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Opinion|Videos|May 2, 2025

Findings in the Docetaxel-Naive Patient Population

A panelist discusses how the findings in the docetaxel-naive population show distinct differences in treatment efficacy, with potentially greater benefits observed for certain androgen receptor pathway inhibitors, which suggests clinicians should consider these differential outcomes when sequencing therapies for patients with metastatic hormone-sensitive prostate cancer (mHSPC) who have not previously received chemotherapy.

Episodes in this series

Summary for Physicians: Findings in DOC-Naive Population and Clinical Implications

In the docetaxel (DOC)-naive population:

  • Treatment benefit appears consistent with the overall study population across both enzalutamide and darolutamide trials.
  • Radiographic progression-free survival improvements remain significant compared with ADT alone.
  • No clear efficacy differences between the agents have been definitively established in this specific subgroup.
  • Treatment sequencing decisions (androgen receptor [AR] pathway inhibitor first vs docetaxel first) remain an area of clinical judgment.

Clinical implications:

  • DOC-naive patients represent an important subgroup that may derive substantial benefit from AR pathway inhibitors.
  • Treatment selection should consider disease burden, patient fitness for chemotherapy, comorbidities, and patient preference.
  • For patients unlikely to tolerate docetaxel, either enzalutamide or darolutamide plus androgen deprivation therapy provides a valuable treatment option.
  • Monitoring for long-term outcomes in this subpopulation remains important as data mature.

These findings support the role of AR pathway inhibitors as effective first-line options in DOC-naive patients with mHSPC.

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