APCCC 2021: Panel Results from the Metastatic Hormone Sensitive Prostate Cancer Session

(UroToday.com) The Advanced Prostate Cancer Consensus Conference 2021 meeting session discussing the management of newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC) included a discussion of the nine key panel questions specific to the mHSPC disease space. Dr. Bertrand Tombal and Dr. Nicholas James started with the results of question #12: In the majority of patients with synchronous high-volume (on conventional imaging or unequivocal on next-generation imaging) mHSPC, what is your preferred systemic treatment in addition to ADT?

1. AR pathway inhibitor (abiraterone/apalutamide/enzalutamide) as sole additional therapy (49% of respondents)
2. Docetaxel as the sole additional therapy (11% of respondents)
3. Docetaxel plus an AR pathway inhibitor (abiraterone/apalutamide/enzalutamide) (40% of respondents)
4. ADT alone (0% of respondents)
5. Abstain (0% of respondents) 

Question #13 then asked In the majority of patients with metachronous high-volume (on conventional imaging or unequivocal on next-generation imaging) mHSPC, what is your preferred systemic treatment in addition to ADT?

1. AR pathway inhibitor (abiraterone/apalutamide/enzalutamide) as sole additional therapy (71% of respondents)
2. Docetaxel as the sole additional therapy (7% of respondents)
3. Docetaxel plus an AR pathway inhibitor (abiraterone/apalutamide/enzalutamide) (21% of respondents)
4. ADT alone (1% of respondents)
5. Abstain (0% of respondents) 

Question #29 asked In which patients with synchronous mHSPC that are chemotherapy fit, do you recommend the triplet therapy ADT plus docetaxel plus abiraterone (in addition to ADT)?

1. In the majority of patients independent of disease volume (4% of respondents)
2. Only in high-volume patients (55% of respondents)
3. I usually do not recommend this combination (41% of respondents)
4. Abstain (1 respondent)

Questions #31 asked In which patients with mHSPC that are chemotherapy fit, do you recommend the triplet therapy ADT plus docetaxel plus enzalutamide or apalutamide?

1. In the majority of patients independent of disease volume and disease stage (synchronous and metachronous)? (0% of respondents)
2. Only in high-volume patients independent of disease stage (21% of respondents)
3. Only in synchronous high-volume patients (19% of respondents)
4. I usually do not recommend this combination (60% of respondents)
5. Abstain (3 respondents)

Question #28 asked What is your recommended treatment strategy, in the majority of patients with mHSPC that have low-volume disease by conventional imaging but high-volume by next-generation imaging?

1. Treat as per high-volume (47% of respondents)
2. Treat as per low-volume (53% of respondents)
3. Abstain (0% of respondents)

Question #15 asked In the majority of patients with symptoms from the primary tumor with synchronous low-volume (conventional imaging) mHSPC, what is your preferred treatment in addition to ADT?

1. Additional systemic therapy (8% of respondents)
2. Radical local treatment of the primary tumor (+/- metastases directed therapy) (14% of respondents)
3. Radical local treatment of the primary tumor plus additional systemic therapy (+/- metastases directed therapy) (77% of respondents)
4. No additional treatment (ADT alone) (1% of respondents)
5. Abstain (0% of respondents)

Question #6 asked For local treatment of the primary tumor in mHSPC, what is the cut-off of the number of bone metastases based on conventional imaging for recommending local treatment of the primary tumor?

1. 3 or less bone metastases (64% of respondents)
2. 5 or less bone metastases (29% of respondents)
3. No upper limit of bone metastases (6% of respondents)
4. I don’t recommend local treatment of the primary in the metastatic setting (1% of respondents)
5. Abstain (1 respondent)

Question #38 asked In patients with mHSPC with a poor response to ADT and docetaxel (PSA of >4 after 6 cycles of docetaxel) do you recommend adding an AR pathway inhibitor at this time point and not wait for the development of CRPC?

1. Yes (59% of respondents)
2. No (41% of respondents)
3. Abstain (2 respondents) 

Finally, question #39 asked In patients with mHSPC with durable deep remission to systemic treatment with PSA undetectable (e.g. <= 0.2 ng/mL at 2-3 years), do you discuss with the patient the possibility of stopping all systemic therapy (ADT +/- AR pathway inhibitor)?

1. Yes (61% of respondents)
2. No (39% of respondents)
3. Abstain (2 respondents)

Presented by:

1. Nicholas D. James, MBBS, FRCP, FRCR, PhD, Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
2. Bertrand Tombal, MD, PhD, Urology, Cliniques universitaires Saint-Luc, UC Louvain, Brussels, Belgium 

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2021 Advanced Prostate Cancer Consensus Conference, Saturday, October 9, 2021.