Metastatic Hormone-Sensitive Prostate Cancer: Data from TITAN and PEACE-1

Transcript:

Alan Bryce, MD: What about apalutamide Dr Heath? Can you speak to the TITAN study?

Elisabeth Heath, MD, FACP: Yes, absolutely. The final results were presented, I think it was in 2021, it was a one to one randomization of apalutamide versus placebo. I'd like to see these updated analyses and if the result is holding. At the first glimpse everyone's excited—here's the first look—then will it hold? Luckily here, the data holds. The OS [overall survival] benefit is still there. Time to castration is still delayed, but more importantly, quality of life data still holds as well. If I was just looking at the big picture, I'm happy at how I think about apalutamide in a way doesn't change. I think most of us in this discussion have our favorite. It's not because we like their favorite drug, it’s just it’s easy in your practice and you already know how to use it. As we get into what pharmacy you use, and to Dr Zhang's point, what is the copay and what are the resources that are required, I think that's how most of us would integrate this data. When I was reading the results of TITAN, I was happy to see there were no changes from the original reporting.

Alan Bryce, MD: Yes. Absolutely. Dr Lowentritt, could you speak to abiraterone in this setting? We have PEACE-1, our other triplet data, and earlier we had the abiraterone doublet data. What does our audience need to understand as they think about this clinical trial?

Benjamin Lowentritt, MD, FACS: PEACE-1 was the first that started reporting in late 2021. It's a different kind of trial; this is I think an entirely European trial. It was designed prior to the standard of care including docetaxel for the MHSPC [metastatic hormone-sensitive prostate cancer] patient. Initially, there were patients that were enrolled and it was made to look at patients getting standard of care plus or minus abiraterone; it also had an arm that had radiation. I was planned for a 2-by-2 analysis, it's a different kind of study, it's not the same as the others. We're still waiting on the radiation arm to report out and to show us if there's anything there. After 2015, docetaxel was encouraged into the standard of care, and it changed midstream. There's a lot of different data, it requires some degree of deep understanding to pull out some of these numbers. There certainly is a benefit seen overall with the triplet therapy of Abi, prednisone and docetaxel that was seen early on. We looked at and heard most recently last fall, of a deeper PSA response, so once again, telling the story through PSA, and it was more suggestive of a longer-term overall survival and progression-free survival. If you could get to what was considered undetectable of less than 0.2, even if the PSA just got below 4 there was a long-term benefit seen in those patients. This may help in how we monitor patients that are going through these therapies and how we counsel them. Recently, at GO ASCO [American Society of Clinical Oncology] there was an update that looked at breaking out by age. It looked at younger versus older, the cut off for them was 70, which is interesting in and of itself that there were enough patients under 70 that qualified as younger. A lot of my 73- or 74-year-old [patients] would not like to be called older. The bottom line is that, in general, the patients that were able to get triplet therapy, there was more benefit in the younger men than the older men. The patients that were older, that could get triplet therapy, that tolerated docetaxel and were able to go onto abiraterone did as well as younger men. It's probably more a statement as to overall fitness than it was necessarily to anything else with age. It seemed to be that chemotherapy piece that was driving the data. I think there is more to come from this, and it will tell us a lot of interesting stories over time. It's definitely a trial to be familiar with.

Elisabeth Heath, MD, FACP: I got to just say, that PSA deck, that's helpful. I engage my patients in that discussion, and they're like, how do you know what this is? Everyone gets excited at 0. I don't mention that, but it's nice if they bring it up. I always say, right around 7, 8 months if you're not below 4, no matter what number you're starting with, we're going to be in a bit of trouble. Then it sets it already there, so when we don't achieve that they go, what are we doing? I'm projecting ahead. It sets the expectation. Most people are not that. There's a good amount in everyone's practice that is that. Then you're ready to go for the next steps. Otherwise, they're still grieving the loss of what do. “You told me I've got years until things move along.” That marker for me is very helpful.

Alan Bryce, MD: It's nuance data but we know that patients are aware of it. They're talking to their friends, they're comparing PSAs, they're online, in chat rooms, et cetera. That gets challenging. Very helpful data. I agree.

Transcript edited for clarity.