On April 25, ASCO issued a provisional clinical opinion on the use of second-line hormonal therapy for men with castration-resistant prostate cancer who have not yet received chemotherapy. The recommendations of this provisional clinical opinion were informed by evidence from a systematic review of the literature published from 1985 through October 2016, consensus opinion, and clinical experience. The Second-Line Hormonal Therapy for Men With Chemotherapy-Naive Castration-Resistant Prostate Cancer: American Society of Clinical Oncology Provisional Clinical Opinion was published by Virgo et al in the Journal of Clinical Oncology.1
Uncertainty Regarding Optimal Treatment
Katherine S. Virgo, PhD
“In the last few years, we have seen an unprecedented number of new systemic therapies showing improvements in survival and quality of life for men with [castration-resistant prostate cancer],” said Katherine S. Virgo, PhD, Co-Chair of the Expert Panel that developed the provisional clinical opinion. “However, due to lack of guidelines on second-line hormone therapy for chemotherapy-naive patients, there has been uncertainty regarding optimal treatment among clinicians.”
Many men with hormone-sensitive prostate cancer experience cancer recurrence or progression despite first-line androgen-deprivation therapy, meaning the cancer is castration-resistant. The provisional clinical opinion addresses the use of second-line hormonal therapy in chemotherapy-naive men with castration-resistant prostate cancer, ranging from asymptomatic men with only biochemical evidence of recurrence to those with measurable metastases but few symptoms.
Clinical trials have shown that second-line hormonal treatments such as abiraterone acetate (Zytiga) and enzalutamide (Xtandi) slow cancer growth, extend survival, and provide meaningful improvement in quality of life for men with castration-resistant prostate cancer.
Eric A. Singer, MD, MA, FACS
“To develop these recommendations, we used evidence from clinical trials as well as a formal consensus technique that relied on clinical experience, training, and judgment when evidence was limited,” said Eric A. Singer, MD, MA, FACS, Co-Chair of the Expert Panel that developed this provisional clinical opinion. “We hope this provisional clinical opinion will offer clinicians and patients timely direction to help inform treatment planning and shared decision making.”
1. Virgo KS, Basch E, Loblaw DA, et al: Second-line hormonal therapy for men with chemotherapy-naive, castration-resistant prostate cancer: American Society of Clinical Oncology provisional clinical opinion. J Clin Oncol. April 25, 2017 (early release online).