Dr. Dorff on Sequencing in Metastatic Castration-Resistant Prostate Cancer

Tanya B. Dorff, MD, associate clinical professor in the Department of Medical Oncology and Therapeutics Research, and head of the genitourinary cancers program at City of Hope, discusses sequencing in metastatic castration-resistant prostate cancer (mCRPC).

Treating physicians have more options now than ever before for the treatment of patients with mCRPC, explains Dorff. Modern therapies have been shown to prolong survival, maintain a good quality of life, and reduce skeletal symptomatic events, says Dorff. However, there is no one right sequence, and in the absence of comparative data between these agents, physicians should individualize each treatment to each patient, she says.

A physician may be inclined to give a patient chemotherapy after they have received either abiraterone (Zytiga) or enzalutamide (Xtandi); however, the patient may be unable to quit their job to receive therapy or he/she may have other comorbidities that may prevent them from receiving the chemotherapy. Radium-223 dichloride (Xofigo) is a suitable option for patients with bone-only or metastatic disease that is limited to the bone, says Dorff, whereas this would not be the appropriate choice for patients with soft tissue and visceral metastases. Moreover, there is immunotherapy with sipuleucel-T (Provenge) for select patients who are minimally symptomatic or asymptomatic, and have slowly progressing disease, she adds.

In addition to considering clinical features to help determine the optimal therapy for patients, imagining can sometimes alert physicians to a potential need to switch or sustain therapy.