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Combination treatment in metastatic prostate cancer: is the bar too high or have we fallen short?

Nature Reviews Urology volume 20, pages 116–123 (2023)Cite this article

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Abstract

Androgen deprivation therapy (ADT) alone has been the cornerstone of treatment for patients with newly diagnosed metastatic prostate cancer for the past century. Based on results from landmark trials in the past decade, combination approaches of ADT with chemotherapy or novel hormonal agents have established a new standard of care for these patients. This paradigm shift in treatment has been reflected in the updates to guideline recommendations of major professional associations. However, real-world data from around the world have highlighted the dismal adoption of combination therapy, despite evidence-based recommendations. The disparity between evidence and practice is concerning, especially with emerging evidence of survival benefit with further treatment intensification using triplet combinations (ADT, docetaxel and novel hormonal agents). Thus, a pressing need to raise awareness and call the uro-oncology community to action exists to deliver evidence-based care for these patients.

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Fig. 1: Adoption of combination treatment in mHSPC.

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Authors and Affiliations

  1. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Kenneth Chen, Jonathan O’Brien, Aoife McVey, Pocharapong Jenjitranant, Brian D. Kelly & Declan G. Murphy

  2. Department of Urology, Singapore General Hospital, Singapore, Singapore

    Kenneth Chen

  3. Department of Urology, University College London Hospitals Trust, London, UK

    Veeru Kasivisvanathan

  4. Department of Urology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Nathan Lawrentschuk

  5. EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, Victoria, Australia

    Nathan Lawrentschuk

  6. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia

    Declan G. Murphy & Arun A. Azad

  7. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Arun A. Azad

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Contributions

D.G.M., K.C., J.O.B., A.M., P.J., B.D.K., V.K. and A.A.A. researched data for the article. All authors contributed substantially to discussion of the content. D.G.M., K.C., J.O.B., A.M., P.J. and A.A.A. wrote the article. D.G.M., K.C., J.O.B., B.D.K., V.K. N.L. and A.A.A. reviewed and/or edited the manuscript before submission.

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Correspondence to Declan G. Murphy.

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Competing interests

D.G.M. has received reimbursement for participation in advisory boards and delivering lectures from Astellas Pharmaceuticals, Janssen Pharma, Bayer, Ipsen, Ferring and AstraZeneca. K.C. has received honoraria for participation in advisory boards and delivering lectures from Astellas, Janssen Pharma, Bayer, AstraZeneca. V.K. receives funding from Prostate Cancer UK and the John Black Charitable Foundation for unrelated work. A.A.A. has been a consultant for Astellas, Janssen, Novartis, Aculeus Therapeutics; a speaker for Astellas, Janssen, Novartis, Amgen, Ipsen, Bristol Myers Squibb, Merck Serono and Bayer; received honoraria from Astellas, Novartis, Sanofi, AstraZeneca, Tolmar, Telix, Merck Serono, Janssen, Bristol Myers Squibb, Ipsen, Bayer, Pfizer, Amgen, Noxopharm, Merck Sharpe Dome, Aculeus Therapeutics; is on the scientific advisory board of Astellas, Novartis, Sanofi, AstraZeneca, Tolmar, Pfizer, Telix, Merck Serono, Janssen, Bristol Myers Squibb, Ipsen, Bayer, Merck Sharpe Dome, Amgen, Noxopharm; received research funding from Astellas (investigator), Merck Serono (investigator), AstraZeneca (investigator), Bristol Myers Squibb (institutional), AstraZeneca (institutional), Aptevo Therapeutics (institutional), Glaxo Smith Kline (institutional), Pfizer (institutional), MedImmune (institutional), Astellas (institutional), SYNthorx (institutional), Bionomics (institutional), Sanofi Aventis (institutional), Novartis (institutional), Ipsen (institutional), Exelixis (institutional), Merck Sharpe Dome (institutional), Janssen (institutional), Eli Lilly (institutional) and Gilead Sciences (institutional). The other authors declare no competing interests.

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Chen, K., O’Brien, J., McVey, A. et al. Combination treatment in metastatic prostate cancer: is the bar too high or have we fallen short?. Nat Rev Urol 20, 116–123 (2023). https://doi.org/10.1038/s41585-022-00669-z

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