The point is that the study population does not exactly reflect the actual scenario, because most patients have received ADT or ADT plus docetaxel in the hormone-sensitive setting. So this should be interpreted with a little bit of caution. Said that, there are other examples of benefit, of overall survival benefit for combinations, for example, or progression-free survival benefit, for example, lutetium with RP, PARP inhibitors with RPs, and so on...
The point is that the study population does not exactly reflect the actual scenario, because most patients have received ADT or ADT plus docetaxel in the hormone-sensitive setting. So this should be interpreted with a little bit of caution. Said that, there are other examples of benefit, of overall survival benefit for combinations, for example, or progression-free survival benefit, for example, lutetium with RP, PARP inhibitors with RPs, and so on. So the point is that, in my view, if you can combine two drugs with complementary mechanisms of action with no significant higher toxicity and you can demonstrate an overall survival benefit, you may consider this option. Of course, patients in the PS3 trial received subsequent survival gain hormone therapies and other therapies. But even in this case, the combination seems to improve the benefit. So it’s difficult to establish a fair sequence. But for example, in our case, for patients having received abiraterone or only docetaxel or only ADT, this combination specifically in patients with bone metastasis should be a good opportunity.
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