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GU Cancers 2023 | Treatment sequencing and combinations for prostate cancer

Silke Gillessen, MD, Oncological Institute of Southern Switzerland, Bellinzona, Switzerland, talks on treatment sequencing and combinations for prostate cancer, including with androgen deprivation therapy (ADT), docetaxel and an endocrine agent in the metastatic hormone-sensitive setting. This interview took place at the ASCO GU Cancers Symposium 2023 in San Francisco, CA.

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Transcript (edited for clarity)

So, I had to talk here, and I think, when I was thinking about how to build up the talk, I realized that, really, the situation has changed. A lot of the trials that we base our decisions on have been really done in an area where we gave ADT alone in the metastatic hormone sensitive setting. And then, we have four scenarios. So, we have still these patients who have received ADT alone in the hormone sensitive setting, but they become less and less, at least I hope so, because we know now that the combinations are so much better...

So, I had to talk here, and I think, when I was thinking about how to build up the talk, I realized that, really, the situation has changed. A lot of the trials that we base our decisions on have been really done in an area where we gave ADT alone in the metastatic hormone sensitive setting. And then, we have four scenarios. So, we have still these patients who have received ADT alone in the hormone sensitive setting, but they become less and less, at least I hope so, because we know now that the combinations are so much better. And then, we have the second scenario where we have given ADT plus docetaxel in the metastatic hormone sensitive space, the third setting where we have given ADT and a novel endocrine agent.

And then, more recently, we have also the triplets where we give ADT chemotherapy, so docetaxel, plus one of the novel endocrine agents. And then, when the patients progressed, obviously, they have already had two of our very powerful drugs. So, it has changed everything a bit. And so, we have four scenarios, and we have to think in these four scenarios. And at least, in my practice, the scenario with giving ADT plus novel endocrine agent is probably the most frequent one now. So, I guess that is one of the key messages that we have to base our treatment decisions on what the patient has received in the metastatic hormone sensitive stage. And then, I guess another important message is that, at least I think for fit patients, we have to try to offer all the options.

And maybe it’s not that important what sequence always, but that we are in time to still give the treatment options. I guess that is important. One thing that is very close to my heart is that we don’t forget the bone-targeted agents because that’s something that is really important for our patients. Because we have seen in multiple trials that, actually, fractures are a problem. And these fractures are not only at the site of metastasis, but also osteoporotic fractures. So, we should really think about also giving these bone targeted agents in addition to our therapies. And then, I guess we speak about that afterwards. I guess the PARP inhibitors have been a bit controversial, and I think we need to find the best setting for the PARP inhibitors.

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