Real-World Data Shows Benefit of Triplet Therapy for Patients With Metastatic Hormone-Sensitive Prostate Cancer

In this real-world study, response to triplet therapy of androgen deprivation therapy [ADT], androgen pathway inhibitor [ARPI], and chemotherapy was promising, with acceptable tolerability among patients with hormone-sensitive prostate cancer. However, non-simultaneous treatment was associated with worse response rates.

Mona Kafka, MD, Medical University Innsbruck, Austria, and coauthors wrote, “implementation of triplet therapy…recently changed the treatment regimens in metastatic hormone-sensitive prostate cancer.” However, “no real world data exists delineating the clinical performance of triplet therapy outside registration trials.”

This analysis included 94 patients with metastatic hormone-sensitive prostate cancer across 16 Austria-based medical centers. Of those patients, 79.4% received abiraterone and 17.5% received daralutamide; 83.5% had synchronous disease and 16.5% had metachronous disease; while 83.5% had high-volume disease. Study authors noted that while docetaxel and ARPI were administered consistent with pivotal trials (PEACE-1 and ARASENS), prednisone, prophylactic granulocyte-colony stimulating factor (G-CSF), and osteoprotective agents were not administered as dictated by guidelines.

Overall, 99% of patients achieved a PSA-based response rate, with confirmed imagining response in 88% of patients who received abiraterone and 75% of patients who received darolutamide. There were 44.3% of patients who had a non-simultaneous initiation of chemotherapy and ARPI, which was associated with a significantly worse treatment response. Initiation of ARPI prior to chemotherapy was associated with a significantly increased risk of progression when compared with starting chemotherapy prior to ARPI. Adverse events occurred in 61.9% of patients, 15% of those being grade 3 to 5, with no age-related differences.

Dr Kafka et al concluded, “Regardless of selected therapy regimen, [triplet therapy] is highly effective and tolerable. Preferably, therapy should be administered simultaneously, however if not possible, chemotherapy should be started first.”

Source:

Kafka M, Giannini G, Artamonova N, et al. Real-world evidence of triplet therapy in metastatic hormone-sensitive prostate cancer – an Austrian multicenter study. Clin Genitourin Can. Published online January 3, 2024. doi: 10.1016/j.clgc.2023.12.018