Which patients with metastatic hormone sensitive prostate cancer would you treat with enzalutamide or apalutamide (instead of abiraterone or docetaxel)?

ENZAMET and TITAN trials published at ASCO 2019 show benefit to both 2nd generation AR antagonists when compared to placebo but wondering how this will change practice given standard of care is abiraterone or docetaxel.

Answer from: Medical Oncologist at Academic Institution

Current studies in mHSPC combining docetaxel or abiraterone or enzalutamide or apalutamide suggest that the standard of care for patients who present with de novo high volume metastatic disease has now changed from single ADT (gonadal androgen suppression) to one of the combinations. At this point i...

Answer from: Medical Oncologist at Academic Institution

I agree with my astute mentor on most of his responses! However, I would not discount the PFS and overall survival benefits of these AR therapies in men with low volume or oligometastatic HSPC. In ENZAMET, for example, the HR for OS in low volume patients is 0.43 (95% CI 0.26-0.72) and A...

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Which patients with metastatic hormone sensitive prostate cancer would you treat with enzalutamide or apalutamide (instead of abiraterone or docetaxel)?

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