The American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO) have published a joint clinical practice guideline on treating men with metastatic castration-resistant prostate cancer (CRPC).
The study entitled “Systemic Therapy in Men with Metastatic Castration-Resistant Prostate Cancer (CRPC): American Society of Clinical Oncology and Cancer Care Ontario Clinical Practice Guideline,” published in the Journal of Clinical Oncology, includes recommendations on systemic therapies indicated as an adjuvant of androgen deprivation, and addresses survival, quality of life benefits, side effects, and cost considerations for each.
“We have seen unprecedented progress against advanced prostate cancer recently, with six new treatments approved in the last couple of years. There are a lot of nuances about treatment selection in terms of disease stage and what prior therapies the patient received. We hope this guideline will help doctors and patients make informed treatment decisions”, Ethan Basch, MD, co-chair of the ASCO/CCO Expert Panel that developed the guideline said in an ASCO press release.
A significant number of men that suffer from hormone-sensitive metastatic prostate cancer end up developing CRPC. Even though androgen deprivation therapy is necessary, there are multiple additional treatment options available that can help to improve survival and quality of life.
“Including quality of life data in the guideline helps people understand how the different treatments will make them feel. We also have to be conscious of cost, because it can affect access to treatment and quality of life”, Andrew Loblaw, MD, co-chair of the ASCO/CCO Expert Panel that developed the guideline and head of the genitourinary disease site group for CCO, added in the press release.
Some of the key guidelines include the recommendation of indefinite androgen deprivation therapy, either through pharmaceutical drugs or surgical intervention, treatment by abiraterone/prednisone, enzalutamide, or radium-223 for men whose cancer spread predominantly to the bones, docexatel/prednisone treatment if chemotherapy is being considered, and cabazitaxel prescribed to men whose disease worsens even though they had treatment with docetaxel.
Addtionally, sipuleucel-T may be offered to men with no symptoms or minimal symptoms, and mitoxantrone, ketoconazole or antiandrogens can be offered but need to be accompanied by discussion of limited clinical benefits. Bevacizumab, estramustine, or sunitinib should not be offered and palliative care should be offered early to all patients.
The new guideline is an improvement on prior recommendations from ASCO and CCO based on a systematic review of 28 randomized clinical trials published between 1979 and 2004.
Since then, an additional 28 randomized clinical trials were analyzed, which included targeted therapies and immunotherapies for the treatment of metastatic CRPC.
Even though there was not enough clinical support to recommend the optimal sequence in which treatments should be administered, ongoing clinical trials are currently addressing this question, along with the potential benefits of combination therapies.