CARE™ Perspectives

ESMO 2021

Focus on Prostate Cancer

Genitourinary

Oncology

11 Nov 2021

Introduction

The annual ESMO 2021 Congress provides updates on scientific developments in Oncology. CARE™ Prostate Cancer Faculty reviewed congress materials and have identified the most relevant clinical trial updates from a Canadian perspective.

Highlights from ESMO 2021

Insights and reviews of select trials covered in this report from Dr. Alan So.

Key Takeaways

Longer-term efficacy data/additional follow-up:

Positive long-term follow up with approaches in high-risk non-metastatic prostate cancer reflect the ongoing evolution of systemic therapies earlier in the disease trajectory of prostate cancer. (LBA4_PR. Combined analysis from two comparisons in the STAMPEDE platform protocol)

  • Approval and access to these strategies in Canada is awaited.

Data for APA + ADT in advanced prostate cancer in older patients demonstrate that some AEs (incl. falls, skin rash, cardio issues) can be worse in older patients. (618P. Combined analysis of TITAN & SPARTAN)

  • When starting men on these agents, a risk-benefit analysis needs to take place.
New data on AEs and QoL considerations:

Additional follow-up from the ARAMIS and ODENZA trials support darolutamide as a very safe option for patients that also improves survival outcomes. (630P. Time course profile of adverse events of interest and serious adverse events with darolutamide in the ARAMIS trial; 603P. Objective computerized cognitive assessment in the ODENZA trial.)

¹⁷⁷Lu-PSMA-617 will be an exciting option for patients in 3rd line or greater when it is available in our treatment centres (576MO. Health-related quality of life (HRQoL), pain and safety outcomes in the phase III VISION study)

In real-world settings, benefits in pain efficacy with Ra-223 were sustained following completion of treatment and complement clinical trial evidence of improved pain-related QoL. (593P. Pain efficacy with radium-223 (Ra-223) in the REASSURE study; 594P. Pain efficacy in the PARABO observational study)

Novel strategies and agents in development:

Results presented with novel agents and strategies, while positive, are not practice changing in Canada at this time

    • In the current treatment landscape where most patients with mCSPC are patients being treated with an ASI up front, the clinical question of adding abiraterone to docetaxel is simply not as relevant as when PEACE-1 was designed (LBA5_PR. A phase III trial with a 2×2 factorial design in men with de novo metastatic castration-sensitive prostate cancer: Overall survival with abiraterone acetate plus prednisone in PEACE-1.)
    • Longer follow-up is needed to better characterize clinical benefits of adding NIVO to rucaparib in CT-naïve mCRPC (579MO. CheckMate 9KD cohort A2 final analysis)