Cancer Therapy AdvisorASCO GU 2024: Advances in Prostate Cancer

Doctors Share Their Insights from Four Recent Trials

Recent research presented at the ASCO Genitourinary Cancers Symposium 2024 has unveiled significant findings that may shape the future of prostate cancer treatment. These studies explore new combinations of therapies, the impact of high-dose radiotherapy, and the effects of treatment on patient quality of life, offering a comprehensive overview of potential advancements in managing metastatic castration-resistant prostate cancer (mCRPC) and high-risk prostate cancer.

Key Points:

• CONTACT-2 Trial Findings: Cabozantinib plus atezolizumab significantly improved progression-free survival (PFS) compared to second novel hormone therapy in patients with mCRPC, suggesting a new treatment option after initial hormone therapy failure.
  • Treatment-Related Adverse Events: The CONTACT-2 trial reported higher rates of treatment-related adverse events in the cabozantinib-atezolizumab arm compared to the hormone therapy arm, emphasizing the importance of managing side effects in new treatment combinations.
  • Subgroup Analyses: In the CONTACT-2 trial, cabozantinib-atezolizumab showed superior PFS for patients with liver or bone metastasis and those who had received prior docetaxel, indicating specific patient populations that may benefit more from this treatment.
  • Overall Survival Data: Preliminary OS data from the CONTACT-2 trial showed a trend towards improvement with cabozantinib-atezolizumab over hormone therapy, though results were not yet statistically significant, suggesting further follow-up is needed to fully understand the impact on survival.
• GETUG-AFU 18 Trial Insights: High-dose radiotherapy combined with long-term androgen deprivation therapy (ADT) resulted in better outcomes than lower-dose radiotherapy and ADT in patients with high-risk prostate cancer, reinforcing the standard of care.
• BRCAAway Study Results: Frontline treatment with olaparib, abiraterone, and prednisone significantly improved outcomes over abiraterone and prednisone or olaparib alone in mCRPC patients with BRCA1, BRCA2, or ATM mutations.
• ACE Study Conclusions: mCRPC patients treated with enzalutamide experienced greater declines in reaction time, and worse fatigue and depression than those treated with abiraterone acetate and prednisolone, highlighting the need for careful consideration of side effects in treatment planning.
  • Patient Quality of Life: The ACE study’s findings on cognitive function and psychological well-being underscore the importance of considering these factors in treatment decisions to ensure a holistic approach to patient care.

“This study [ACE] was more reinforcing [past findings] than new knowledge. A lot of people have avoided agents like enzalutamide or apalutamide in older patients when possible because they’ve already known about the cognitive function issues. This study gives more of a breakdown of what parts of the cognitive decline we see. That is useful for patient counseling in cases where they can’t get abiraterone.”
– Wesley Yip, MD, City of Hope in Duarte, California

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