ESMO E-Learning: Sequencing in Metastatic Prostate Cancer Treatment

Learning Objectives

  • To provide an update on clinical trials in patients with metastatic prostate cancer
  • To critically discuss available evidence in terms of treatment sequencing in patients with metastatic prostate cancer
  • To analyse, from the clinical perspective relevance, different parameters important for treatment decision in patients with metastatic prostate cancer
Title Duration Content CME Points CME Test
Sequencing in Metastatic Prostate Cancer Treatment 37 min. 74 slides 1 Take Test
maragkouli-eleni
Eleni Maragkouli
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This E-Learning module contextualizes currently available data in terms of drug sequencing in the treatment of metastatic prostate cancer. It is important that agents approved in the clinic have different mechanism of action, thereby providing an opportunity to develop predictive markers for treatment application. An important message drawn from drug development for castration resistant prostate cancer (CRPC) is that only one of the newest drugs is a chemotherapeutic, while two target different components of androgen signalling pathway.  

In this E-Learning module, the author summarises the results from different studies with agents active in the post-docetaxel, but also in the pre-docetaxel setting. Trying to answer the question “which drug to which patient”, the author underlines that there are no prospective sequencing or head to head studies to guide treatment choices in metastatic CRPC.

The author elaborates laboratory, clinical, radiographic and other parameters important for regimen sequencing and furthermore provides level of evidence in terms of patient and tumour characteristics influencing treatment decisions.

In terms of sequential administration of new agents, the author points out to shortcomings such as few clinical trials, retrospective uncontrolled post hoc analysis, small sample size, short follow-up, evaluation of objective responses not always comparable, evaluation of cumulative results and not patients’ individual data, prognostic variables that may influence the clinical outcomes.

Besides such difficulties to sum up safe conclusions, the author elaborates on other considerations such as proper evaluation of disease, different approaches to define disease volume, if progression-free survival is a surrogate for overall survival, impact of subsequent treatments, and resistance mechanisms.

The author also considers the question of who should be a candidate for early chemotherapy in case of hormone sensitive disease.

In conclusion, the author emphasises that ideal treatment sequence in the therapeutic scenario for metastatic prostate cancer is not known. Resistance mechanisms and biomarkers, if elucidated better, could provide insight into treatment selection.

Last update: 27 March 2018

The author has reported sponsored presentations by Sanofi, Genesis, Janssen, Novartis and Astellas.