Practice-changing developments in early use of chemohormonal therapy in metastatic prostate cancer

Summary

The STAMPEDE and CHAARTED trials brought about practice-changing innovation in the management of patients with metastatic, castration-naive prostate cancer (CNPC). These trials reported a clinically meaningful overall survival benefit of chemohormonal therapy consisting of the addition of six cycles of docetaxel to androgen deprivation therapy (ADT) in high-volume metastatic CNPC. Moreover, the STAMPEDE study also transformed our thinking about conducting clinical trials through its adaptive, multigroup, multistage trial design. With the recent results of the LATITUDE trial and publication of another STAMPEDE cohort, the combination of ADT and abiraterone/prednisone became a viable alternative to chemohormonal therapy. Results of these trials have been exhaustively scrutinized and finally incorporated in recent guidelines, although the appropriate selection of patients who will benefit from either therapeutic option remains to be discussed individually. As both combinations lead to an almost identical survival benefit, the decision is often based on patient-related factors and/or personal preferences. This short review provides evidence to support decision-making between chemohormonal therapy and the combination of ADT plus abiraterone/prednisone as well as an outlook on current therapeutic developments in advanced prostate cancer.