Docetaxel Provides Oncological Benefits in the Era of New-Generation Androgen Receptor Inhibitors - or Is Three a...

Area of Science:

• Oncology
• Prostate Cancer Research
• Systemic Therapy

Background:

• Metastatic hormone-sensitive prostate cancer (mHSPC) treatment has evolved with new systemic therapies.
• Androgen deprivation therapy (ADT) combined with docetaxel (Doc) or new-generation androgen receptor signaling inhibitors (ARSI) have shown improved survival outcomes.
• Combination therapies leverage distinct antitumor mechanisms of ADT, Doc, and ARSI.

Approach:

• This narrative review synthesizes current evidence comparing triplet therapy (ADT + Doc + ARSI) with doublet therapy (ADT + ARSI) for mHSPC.
• The review addresses the unanswered question of whether triplet therapy offers superior outcomes to ADT + ARSI.
• It analyzes data from randomized trials and meta-analyses evaluating different combination strategies.

Key Points:

• ADT + ARSI consistently demonstrates an overall survival (OS) benefit over ADT alone.
• ADT + Doc also shows an OS benefit compared to ADT alone, as supported by the STOPCaP meta-analysis.
• Adding ARSI to ADT + Doc has shown improved OS, particularly in high-volume disease, but direct comparisons with ADT + ARSI are lacking.

Conclusions:

• While triplet therapy (ADT + Doc + ARSI) is being explored, its definitive benefit over ADT + ARSI in mHSPC remains uncertain due to the absence of head-to-head trials.
• Further research is needed to establish optimal treatment strategies for mHSPC.
• This review provides a summary of existing data to inform clinical decision-making regarding combination therapies.