Current Prostate Cancer Treatments in Human Clinical Trials

Novel Hormone Therapies and Combinations

The European Society for Medical Oncology recommends triplet therapy combining ADT+docetaxel+darolutamide for metastatic hormone-sensitive prostate cancer (mHSPC), showing significant overall survival benefits (OS gain: 23.0 months, HR: 0.68) 1, 2
The European Society for Medical Oncology recommends ADT+docetaxel+abiraterone+prednisone combination as first-line treatment for fit men with de novo mHSPC, especially those with multiple bone metastases or visceral metastases 1, 3
Novel hormone agents (NHAs) plus ADT, including abiraterone+prednisone, apalutamide, or enzalutamide, are being evaluated for first-line treatment of mHSPC 1

Olaparib, a PARP inhibitor, is being investigated after novel androgen receptor axis inhibitors for patients with mCRPC and BRCA1/2 alterations, showing improved overall survival (HR 0.69, 95% CI 0.50-0.97) 1, 3
Trials examining newer agents in the castration-naïve setting are emerging, potentially supporting the upfront use of agents such as docetaxel 4
Predictive markers to facilitate the selection of patients for specific therapies or sequences of therapies remain an unmet need and are being actively investigated 4, 5

Lutetium-177 prostate-specific membrane antigen (177Lu-PSMA-617) in combination with best standard of care has shown improved radiographic progression-free survival (rPFS) and overall survival in men with mCRPC pretreated with at least one taxane and one novel androgen receptor axis inhibitor 1, 3, 6

The St Gallen Advanced Prostate Cancer Consensus Conference (APCCC) Expert Panel strongly encourages the inclusion of men with advanced prostate cancer in clinical trials 4, 5
Participation in clinical trials is particularly important given the rapidly evolving treatment landscape and the need to identify optimal treatment sequences and combinations 4, 5

Novel imaging methods for patient selection and response claiming increased sensitivity and specificity have not been adequately tested in prospective clinical trials 4
Treatment selection should consider disease extent and location, prior treatments, host factors, patient preferences, and logistical and economic constraints 4, 5
Global access to new therapeutics varies across regions, and the financial burden to patients and healthcare systems must be factored into treatment decisions 5
Careful patient selection is crucial, as some castration-resistant phenotypes may be more responsive to hormonal strategies, others to cytotoxics, and others to biologic approaches 4, 5