Prostate Cancer Foundation White Paper on Combination Therapy for Metastatic Hormone-Sensitive Prostate Cancer

Despite several randomized controlled trials demonstrating the benefits of combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC), a significant treatment gap persists. This initiative by the Prostate Cancer Foundation (PCF) convened stakeholders from academia, community practices, industry, and patient advocacy groups to address critical challenges in mHSPC care. Expert discussions and a review of real-world evidence and meta-analyses informed the development of strategies to improve care delivery. Evaluation of the data from global registries, such as IRONMAN, and large community databases was used to assess treatment utilization patterns and disparities. Combination therapies with two agents-androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI)-or three agents-ADT + ARPI + docetaxel-demonstrate significant survival improvements while preserving quality of life for patients with mHSPC, yet adoption remains inconsistent. Of the eligible patients, 20%-60% remain undertreated, with geographic, financial, and systemic barriers contributing to inconsistencies in care. Younger, White, urban-dwelling patients with fewer comorbidities are more likely to receive combination treatment, highlighting disparities across populations. Meta-analyses identified a lack of standardization due to varying inclusion criteria and comparators across trials. Real-world evidence underscored disparities influenced by geographic location, practice type, and access to specialty care. Initiatives such as the PANTHER study highlight improved outcomes in Black patients treated with combination therapies, emphasizing the importance of including diverse populations in clinical trials. To bridge gaps in care, this initiative prioritizes awareness, standardization, and equitable access to evidence-based therapies. Proposed solutions include targeted knowledge dissemination strategies, development of educational resources, and advocacy for policy changes to promote guideline-concordant care. By leveraging collaborative efforts, organizations, including PCF, can contribute to enhancing survival outcomes and quality of life for all patients with mHSPC.

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Publication Details

Journal
JCO Oncology Practice
Published
2025-05-02
DOI
https://doi.org/10.1200/op-25-00050
Citations
3
Primary Topic
Prostate Cancer Treatment and Research
Type
article
Field-Weighted Citation Impact
4.56
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article

Prostate Cancer Foundation White Paper on Combination Therapy for Metastatic Hormone-Sensitive Prostate Cancer

Silke Gillessen, Kenneth K. Iwata, Irbaz Bin Riaz, Geeta Devgan et al.
3 citations
JCO Oncology Practice
Prostate Cancer Treatment and Research
4.56
article

Prostate Cancer Foundation White Paper on Combination Therapy for Metastatic Hormone-Sensitive Prostate Cancer

Silke Gillessen, Kenneth K. Iwata, Irbaz Bin Riaz, Geeta Devgan, Daniel J. George, Alan Haruo Bryce, Gaston Kuperman, Stacy Loeb, Brandon Cornell, Pankaj Aggarwal, Pedro Coelho Barata, Bruce Montgomery, Martin William Schoen, Ganesh S. Palapattu, Enrique Leñero, Howard R. Soule, Samuel L. Washington, Gina Carithers, Betty Thompson, William Oh, Matthew J. Cotter, Sigrid Carlsson, David S. Morris, Neeraj Agarwal, David Russell, Rebecca Levine, Tracy McGowan, Andrea K. Miyahira
article en
3 citations

Abstract

Despite several randomized controlled trials demonstrating the benefits of combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC), a significant treatment gap persists. This initiative by the Prostate Cancer Foundation (PCF) convened stakeholders from academia, community practices, industry, and patient advocacy groups to address critical challenges in mHSPC care. Expert discussions and a review of real-world evidence and meta-analyses informed the development of strategies to improve care delivery. Evaluation of the data from global registries, such as IRONMAN, and large community databases was used to assess treatment utilization patterns and disparities. Combination therapies with two agents-androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI)-or three agents-ADT + ARPI + docetaxel-demonstrate significant survival improvements while preserving quality of life for patients with mHSPC, yet adoption remains inconsistent. Of the eligible patients, 20%-60% remain undertreated, with geographic, financial, and systemic barriers contributing to inconsistencies in care. Younger, White, urban-dwelling patients with fewer comorbidities are more likely to receive combination treatment, highlighting disparities across populations. Meta-analyses identified a lack of standardization due to varying inclusion criteria and comparators across trials. Real-world evidence underscored disparities influenced by geographic location, practice type, and access to specialty care. Initiatives such as the PANTHER study highlight improved outcomes in Black patients treated with combination therapies, emphasizing the importance of including diverse populations in clinical trials. To bridge gaps in care, this initiative prioritizes awareness, standardization, and equitable access to evidence-based therapies. Proposed solutions include targeted knowledge dissemination strategies, development of educational resources, and advocacy for policy changes to promote guideline-concordant care. By leveraging collaborative efforts, organizations, including PCF, can contribute to enhancing survival outcomes and quality of life for all patients with mHSPC.

JCO Oncology PracticeVol. 21(9)
Johnson & Johnson (United States) (US), Memorial Sloan Kettering Cancer Center (US), Harvard University (US), University of Puget Sound (US), University of California, San Francisco (US), Pfizer (United States) (US), Lund University (SE), University of Washington (US), University of Utah (US), University of Michigan (US), Prostate Cancer Foundation (US), Huntsman Cancer Institute (US), Yale Cancer Center (US), Fred Hutch Cancer Center (US), Urology Associates (US), Institute of Oncology Research (CH), City of Hope (US), University Hospitals Seidman Cancer Center (US), Duke Medical Center (US), Goodyear (United States) (US), VA St. Louis Health Care System (US), Patient Advocate Foundation (US), Astellas Pharma (United States) (US), Saint Louis University (US), Università della Svizzera italiana (CH), New York University (US), Case Western Reserve University (US), University of Gothenburg (SE)
Reduced inequalities
Openalex Percentile: Top 6%
Prostate Cancer Treatment and Research
4.56
DOIOpen Access PDFOpenAlex
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