Future Directions and Novel Combination Therapies for mCSPC


Drs Agarwal and Chowdhury discuss future directions for mCSPC, including potential use of triplet combination therapy.

Simon Chowdhury, MD: In terms of the next steps with these data, there have been 2 studies—1 from a press release, 1 that’s been presented in all abstracts—that look at triplet therapy, where they’re looking at a backbone of ADT [androgen deprivation therapy] and docetaxel. What are your thoughts about the triplets?

Neeraj Agarwal, MD: That’s a great point. I’m glad you raised this, Simon. Two studies have shown that if you add novel hormonal therapy to the backbone of ADT plus docetaxel, the triplet therapy improves survival compared with ADT plus docetaxel. However, we don’t have any studies showing that adding docetaxel chemotherapy to the backbone of ADT plus novel hormonal therapy improves overall survival. Given that, it’s perfectly reasonable to treat our patients with a doublet therapy of ADT plus novel hormonal therapy, such as apalutamide, based on the paper we’re discussing.

This is even more important when we realize that doublet therapies aren’t being used at the community level in the real-world setting. I’d rather emphasize implementation of an intensified doublet regimen for now and not worry about triplet therapy, at least in the near future. At least we have the trial results showing that adding docetaxel to the backbone of ADT plus novel hormonal therapy improves overall survival. Those would be my next steps.

Simon Chowdhury, MD: That’s beautifully put, and it shows a great awareness of these data—particularly data that aren’t even published fully—but also with a pragmatism around it that many people seem to miss. Sometimes we work in quite a rarefied atmosphere, and people debate the fine details without understanding what’s going on in the clinics just down the road from them. I’m sometimes guilty of that myself, so it’s useful to have guidance from people like you and others.

Neeraj Agarwal, MD: It was a great pleasure to discuss our paper on final overall survival data from the TITAN phase 3 trial, which investigated the efficacy and safety of apalutamide in patients with newly diagnosed metastatic castration-sensitive prostate cancer, with the world-recognized expert Dr Simon Chowdhury. I’m very glad to be here. Thank you to our listeners for having patience with us.

Simon Chowdhury, MD: Thank you to everyone for joining us. It’s a real pleasure. I’ve missed travel, but I really miss seeing people like Neeraj, because as you can tell, I’ve enjoyed this, and I’m smiling even seeing him at a distance. I’d also like to thank the organizers who have done a lot of work. It’s always difficult to get me in the right place at the right time. All the AV [audiovisual] people have done a brilliant job. What we’ve seen today is a meaningful paper, and we need to go into the clinic, think about this, and do all we can to implement these very meaningful data to benefit men with prostate cancer. Thank you all, and we hope to see you in person in the not-too-distant future.

Transcript edited for clarity.

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