HOW TO OPTIMALLY SEQUENCE AVAILABLE THERAPY LINES IN ADVANCED PROSTATE CANCER

by Selleckchem | Apr 08 2023

Optimal sequencing of available therapy lines in patients with advanced prostate cancer often poses quite a challenge. The guidelines are sometimes equivocal and clinical trial data are not always applicable to a particular patient. There is a difference in availability of therapy options throughout the world. In decision making, a patient as a whole should be taken into consideration, not just the stage and biology of the disease, but also patient's age, performance status, comorbidities, previous therapy lines, drug's safety profile and patient's preferences. This review article will show certain therapeutic options in the treatment of advanced hormone-sensitive prostate cancer and castration resistant prostate cancer: non- metastatic and metastatic. An attempt will be made to clarify the optimal sequencing.

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Treatment decisions for patients with advanced prostate cancer should be individualized and based on several factors, including the stage and biology of the disease, the patient's age, performance status, comorbidities, previous therapy lines, drug's safety profile, and patient preferences. The optimal sequencing of available therapy lines may vary based on these factors, and clinical guidelines may be equivocal or not applicable to a particular patient.

In general, the treatment of advanced hormone-sensitive prostate cancer (AHSPC) may involve androgen deprivation therapy (ADT) with or without concurrent chemotherapy, followed by second-line therapy with either abiraterone acetate or enzalutamide. Patients with castration-resistant prostate cancer (CRPC) may receive additional therapies, such as docetaxel, radium-223, or sipuleucel-T.

For patients with non-metastatic CRPC, treatment options may include ADT with or without concurrent therapy with apalutamide, enzalutamide, or darolutamide. For patients with metastatic CRPC, the optimal sequencing of available therapy lines may depend on several factors, including the patient's previous therapy lines and the availability of therapies in the patient's region.

In general, the first-line therapy for metastatic CRPC may involve ADT with either abiraterone acetate plus prednisone or enzalutamide. Patients who progress after this therapy may receive second-line therapy with either docetaxel or cabazitaxel, followed by third-line therapy with either abiraterone acetate or enzalutamide. Other therapies, such as radium-223 or sipuleucel-T, may also be considered.

Overall, the optimal sequencing of available therapy lines for patients with advanced prostate cancer should be based on individual patient factors, including the stage and biology of the disease, the patient's age, performance status, comorbidities, previous therapy lines, drug's safety profile, and patient preferences. Clinical guidelines may be helpful in guiding treatment decisions, but ultimately, the decision should be made in collaboration with the patient and their healthcare team.