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PEER-T0-PEER CLINICAL CONVERSATIONS |
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| 2024 NCCN Guidelines: Managing Bone Health in Prostate Cancer Patients |
Rashid Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
Rashid Sayyid and Zach Klaassen review the 2024 NCCN prostate cancer guideline updates focusing on treatment-related bone loss in patients on androgen deprivation therapy. |
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| PEACE-3 Trial Results: Radium-223 + Enzalutamide in mCRPC |
| Bertrand Tombal, MD, PhD |
| Oliver Sartor interviews Bertrand Tombal about the PEACE-3 trial. The study investigates the combination of radium-223 and enzalutamide in asymptomatic or mildly symptomatic patients with bone metastatic castration-resistant prostate cancer. |
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SPLASH Trial Highlights Radiopharmaceutical Lutetium-177’s Role in Advanced Prostate Cancer Treatment
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Oliver Sartor, MD
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| Oliver Sartor discusses the SPLASH trial results, evaluating Lutetium-177-PNT2002 in metastatic castration-resistant prostate cancer patients who progressed on ARPI therapy. The study shows significant improvement in radiographic progression-free survival for Lutetium-177-PNT2002 compared to alternate ARPI therapy, with a hazard ratio of 0.71.
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| Radioligand Therapy for Metastatic Castrate-Resistant Prostate Cancer: Radium-223, 177Lu-PSMA-617, New Agents, and Novel Combinations |
| Zachary Klaassen, MD, MSc, and Rashid Sayyid, MD, MSc |
| The treatment landscape for metastatic castrate-resistant prostate cancer (mCRPC) has expanded with the introduction of FDA-approved radioligand therapies like Radium-223 and Lutetium-177 PSMA-617. Radium-223, a bone-targeting alpha emitter, is effective in patients with bone metastases, improving overall survival and quality of life with minimal toxicity. |
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| The Importance of Bone Protection |
| Noel Clarke, MBBS, FRCS, ChM |
| Noel Clarke emphasized the importance of bone protection in advanced prostate cancer, noting that fracture risk is significantly higher in metastatic patients, especially those on androgen deprivation therapy (ADT). Data from the STAMPEDE trials showed that adding treatments like abiraterone acetate with prednisone ± enzalutamide can reduce fracture-related hospitalizations in metastatic hormone-sensitive prostate cancer (mHSPC), but not in non-metastatic settings. |
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| The Impact of Baseline PSMA PET/CT Versus CT on Outcomes of 223Ra Therapy in Metastatic Castration-Resistant Prostate Cancer Patients - Beyond the Abstract |
| Dianne Bosch, MD & Maarten van der Doelen, MD, Phd |
| A study analyzing the impact of baseline imaging on outcomes of radium-223 therapy in mCRPC showed that patients who received PSMA PET/CT before treatment had significantly longer overall survival compared to those who underwent conventional CT imaging. The PSMA PET/CT group also had no cases of newly detected soft tissue involvement during post-therapy, suggesting that PSMA PET/CT's superior sensitivity helps better select patients for radium-223 therapy and improve outcomes. |
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| Novel Approaches of Combination PSMA-Based Radiopharmaceutical Treatments for Prostate Cancer
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| James Buteau, MD, FRACP, FRCPC
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| James Buteau discussed three ongoing trials exploring combination PSMA-based radiopharmaceutical therapies for metastatic castration-resistant prostate cancer. The VIOLET, AlphaBet, and LuCAB trials aim to improve treatment efficacy by combining radioligand therapies like Terbium-161, Radium-223, and Lutetium-177 with additional agents to target micrometastases, bone metastases, and resistance mechanisms in mCRPC.
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| The Current Landscape of Stereotactic Body Radiation Therapy for Metastatic Castration-Resistant Prostate Cancer - Beyond the Abstract
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| Jennifer Le Guevelou, Francesco Cuccia, Ronan Flippot et al.
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| Stereotactic body radiation therapy (SBRT) is increasingly being explored for oligometastatic or oligoprogressive CRPC. Studies, such as the ARTO trial, suggest that combining SBRT with androgen receptor pathway inhibitors like abiraterone and prednisone can significantly improve biochemical response and progression-free survival. While SBRT shows promise in prolonging the efficacy of systemic treatments, especially in oligoprogressive settings, more prospective trials are needed to fully establish its impact on overall survival and optimal treatment strategies.
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| Radium-223 and Enzalutamide in Asymptomatic or Mildly Symptomatic Patients with Bone Metastatic Castration-Resistant Prostate Cancer: First Results of EORTC-GUCG 1333/PEACE-3 |
| Silke Gillessen Sommer, MD |
| Silke Gillessen presented the initial results from the PEACE-3 trial, which tested the combination of radium-223 and enzalutamide in patients with asymptomatic or mildly symptomatic bone mCRPC. The combination therapy showed a significant improvement in radiographic progression-free survival and overall survival compared to enzalutamide monotherapy. |
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