Earle Burgess: Which newly diagnosed metastatic castrate-sensitive prostate cancer patients need to add docetaxel chemotherapy to an ADT + ARPI doublet?

Quoting Earle Burgess, Genitourinary Medical Oncologist and Clinical Researcher at Atrium Health, Levine Cancer Institute, on LinkedIn:

“Which newly diagnosed metastatic castrate-sensitive prostate cancer (mCSPC) patients need to add docetaxel chemotherapy to an ADT + androgen receptor pathway inhibitor (ARPI*) doublet?

This remains a key question for mCSPC patients. Two trials (PEACE-1 and ARASENS) showed that triplicate therapy with ADT + docetaxel + ARPI is better than ADT + docetaxel.
But is a triplicate regimen necessary for all mCSPC patients?

To address this question, patient subgroups in the ARASENS trial were recently analyzed:
All subgroups had an improved overall survival with use of the triplicate regimen except one: those with a “low-volume” metastatic burden, as defined by the CHAARTED trial.**

Bottom line: No good evidence currently exists to support including docetaxel in front-line regimens for low-volume** mCSPC patients.

*ARPIs = abiraterone, darolutamide, enzalutamide, apalutamide
**High-volume by CHAARTED criteria = presence of visceral (organ) metastasis and/or 4+ bone metastasis with at least one lesion outside of the spine and pelvis; Low-volume = everyone else.”

For the article click here.
Source: Earle Burgess/LinkedIn