Second-line hormonal therapy for men with chemotherapy-naive, castration-resistant prostate cancer: American society of clinical oncology provisional clinical opinion

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  • Virgo, K.S.
    • Other Affiliation: Emory University
  • Basch, E.
    • Affiliation: University of North Carolina at Chapel Hill
  • Andrew Loblaw, D.
    • Other Affiliation: Sunnybrook Health Sciences Centre
  • Oliver, T.K.
    • Other Affiliation: American Society of Clinical Oncology
  • Rumble, R.B.
    • Other Affiliation: American Society of Clinical Oncology
  • Carducci, M.A.
    • Other Affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Nordquist, L.
    • Other Affiliation: Urology Cancer Center and GU Research Network
  • Taplin, M.-E.
    • Other Affiliation: Dana-Farber Cancer Institute
  • Winquist, E.
    • Other Affiliation: London Health Sciences Centre
  • Singer, E.A.
    • Other Affiliation: Rutgers Cancer Institute of New Jersey
Abstract
  • ASCO provisional clinical opinions (PCOs) offer direction to the ASCO membership after publication or presentation of potential practice-changing data. This PCO addresses second-line hormonal therapy for chemotherapy-näive men with castration-resistant prostate cancer (CRPC) who range from being asymptomatic with only biochemical evidence of CRPC to having documented metastases but minimal symptoms. Clinical Context The treatment goal for CRPC is palliation. Despite resistance to initial androgen deprivation therapy, most men respond to second-line hormonal therapies. However, guidelines have neither addressed second-line hormonal therapy for nonmetastatic CRPC nor provided specific guidance with regard to the chemotherapy-näive population. Recent Data Six phase III randomized controlled trials and expert consensus opinion inform this PCO. Provisional Clinical Opinion For men with CRPC, a castrate state should be maintained indefinitely. Second-line hormonal therapy (eg, antiandrogens, CYP17 inhibitors) may be considered in patients with nonmetastatic CRPC at high risk for metastatic disease (rapid prostate-specific antigen doubling time or velocity) but otherwise is not suggested. In patients with radiographic evidence of metastases and minimal symptoms, enzalutamide or abiraterone plus prednisone should be offered after discussion with patients about potential harms, benefits, costs, and patient preferences. Radium-223 and sipuleucel-T also are options. No evidence provides guidance about the optimal order of hormonal therapies for CRPC beyond second-line treatment. Prostate-specific antigen testing every 4 to 6 months is reasonable for men without metastases. Routine radiographic restaging generally is not suggested but can be considered for patients at risk for metastases or who exhibit symptoms or other evidence of progression. Additional information is available at www.asco.org/genitourinary-cancer-guidelines and www.asco.org/guidelineswiki.
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  • Article
Rights statement
  • In Copyright
Journal title
  • Journal of Clinical Oncology
Journal volume
  • 35
Journal issue
  • 17
Page start
  • 1952
Page end
  • 1964
Language
  • English
ISSN
  • 0732-183X
Publisher
  • American Society of Clinical Oncology

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