Sequencing Therapy for Metastatic Castration-Resistant Prostate Cancer

In season 2, episode 9 of Targeted Talks, Sandy Srinivas, MD, medical oncologist, urologic specialist, genitourinary specialist, professor of Medicine of Urology Clinical Research Group leader, Urologic Program Stanford Healthcare and Nicholas J. Vogelzang, MD, chairman, Medical Oncology, Comprehensive Cancer Centers in Las Vegas, NV, discuss the optimal sequencing of therapies for a specific patient with metastatic castration-resistant prostate cancer (mCRPC).

The initial treatment for the 75-year-old patient of discussion was external beam radiation and androgen deprivation therapy for a period of 18 months. This strategy was selected based on the clinical work-up of the patient which showed a prostate-specific antigen level of 32.6 ng/mL, a Gleason score of 4 + 4 in the 4th grade group, as well as negative bone and abdominal pelvic CT scan.

Srinivas and Vogelzang provided their expert opinions on frontline therapy for the patients, along with advice on how to choose between chemotherapy and androgen receptor-targeted therapy, how to intervene if the patient progresses, and how to mitigate toxicities.

Several studies were mentioned to support each physician’s therapy choices for the patient. Most notably, the CARD trial (NCT02485691) of cabazitaxel versus AR-targeted therapy in patients with mCRPC previously treated with docetaxel or quickly failed of AR-targeted therapy.