Chemohormonal therapy for metastatic hormone-sensitive prostate cancer: An Asian perspective

The treatment of metastatic hormone-sensitive prostate cancer (mHSPC) has been rapidly evolving. In the past, the use of chemotherapy was reserved for metastatic prostate cancer patients who developed castration resistance. Subsequently, there were three well-designed randomized controlled trials investigating the use of chemotherapy together with androgen deprivation therapy as the first-line treatment for metastatic hormone-sensitive prostate cancer. The GETUG-AFU 15 study was a negative trial, but the subsequent CHAARTED and STAMPEDE studies demonstrated magnificent survival benefit in the mHSPC setting. Since then, the use of chemohormonal therapy has become accepted and popularized worldwide. However, these results were largely based on Caucasians. Because of the genetic and physiological differences between different ethnicities, there has been concern over whether these results could be readily translated to the Asian population. Would Asians in general have a different tolerability towards chemohormonal therapy? Would prostate cancer in the Asian population have a different biological response towards chemohormonal therapy? In this review paper, we will present the available data regarding the use of chemohormonal therapy for mHSPC and discuss their implications from an Asian perspective.