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PEER-TO-PEER CLINICAL CONVERSATIONS |
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ZZ-FIRST Trial Demonstrates High PSA Response with Combination Therapy
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Joaquin Mateo, MD, PhD
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| Zach Klaassen interviews Joaquín Mateo about the ZZ-FIRST trial, which explores the combination of enzalutamide and talazoparib in metastatic hormone-naive prostate cancer. Dr. Mateo discusses the trial design, preliminary results, and the rationale behind combining AR-targeting agents with PARP inhibitors.
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ARANOTE Study: Transforming Metastatic Hormone-Sensitive Prostate Cancer Treatment
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Fred Saad, MD, FRCS
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| Fred Saad discusses the ARANOTE phase 3 study results, evaluating darolutamide plus ADT in metastatic hormone-sensitive prostate cancer. The trial shows significant improvement in radiographic progression-free survival and secondary endpoints, including time to metastatic CRPC and pain progression.
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2024 NCCN Prostate Cancer Guidelines: Updates in M1 CSPC Treatment
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Rashid Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
Rashid Sayyid and Zachary Klaassen discuss the 2024 NCCN prostate cancer guidelines updates for systemic therapy in mHSPC. They highlight the new stratification of treatment recommendations based on disease volume and timing of metastases.
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| State-of-the-Art Lecture: How to Personalize Treatment in mHSPC? More than Just Counting Metastases
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| Karim Fizazi, MD, PhD
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| Karim Fizazi's lecture on personalizing treatment for mHSPC emphasized that beyond counting bone metastases, factors like timing and burden of metastases are critical for treatment decisions. For low-volume, de novo mHSPC, ADT + ARPI and possibly radiotherapy are recommended, with triplet therapy considered for young, fit patients with bone-predominant disease. In high-volume mHSPC, triplet systemic therapy is the standard.
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| HARMONY: A Phase II Study of Niraparib/Abiraterone Acetate plus Prednisone for Hispanic/Latino and Non-Hispanic Black Patients with Metastatic Hormone-Sensitive Prostate Cancer and Deleterious Homologous Recombination Repair Alterations
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| Qian Qin MD
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| The HARMONY trial is a phase II study evaluating the combination of niraparib, abiraterone acetate, and prednisone in Hispanic/Latino and non-Hispanic Black patients with metastatic hormone-sensitive prostate cancer and homologous recombination repair alterations. The trial aims to address racial disparities in prostate cancer treatment by exploring the efficacy of this combination in these minority groups, using an adaptive approach based on PSA levels to guide ongoing treatment.
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| Adding Metformin to ADT for Patients with mHSPC: Overall Survival Results from the Multi-Arm, Multi-Stage Randomized Platform Trial STAMPEDE
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| Silke Gillessen Sommer, MD
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| Silke Gillessen Sommer presents the results from the STAMPEDE trial, which assessed adding metformin to androgen deprivation therapy in patients with metastatic hormone-sensitive prostate cancer. The study found no significant overall survival benefit from metformin in unselected patients. However, there was some indication of benefit in patients with high-volume disease.
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| mHSPC: Optimizing Combination Therapy
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| Paul Sieber, MD |
| Paul Sieber provided insights into optimizing combination therapy for metastatic hormone-sensitive prostate cancer. The session highlighted the consensus across guidelines that doublet therapy with androgen deprivation therapy and an androgen receptor pathway inhibitor (ARPI) is the standard treatment for mHSPC, regardless of disease volume. |
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| Synchronous Low-Volume mHSPC – In Which Patients Do You Recommend Combination Systemic Therapy Plus Local Treatment of the Primary and in Which Patients is ADT Alone Plus Radiotherapy Enough?
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| Robert Jones, MD, PhD
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| Robert Jones discusses the treatment of synchronous low-volume mHSPC, highlighting that combination systemic therapy with local treatment may not significantly improve overall survival compared to ADT + ARPI alone, based on findings from trials like PEACE-1. However, radiotherapy did improve genitourinary outcomes. Dr. Jones emphasized considering patient life expectancy, metastatic progression risk, and ARPI contraindications when deciding treatment
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| Comparison of Outcomes with Docetaxel or ARPI Combination Therapy for mHSPC by Volume of Disease
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| Martin W. Schoen, MD, MPH |
| Martin Schoen presents a study comparing outcomes between docetaxel and androgen receptor pathway inhibitor combination therapy for metastatic hormone-sensitive prostate cancer based on disease volume. This study, conducted in the Veterans Health Administration, found no significant difference in overall survival between docetaxel and ARPI therapy for both high- and low-volume mHSPC patients.
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