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PCa coverage at ASCO21: Updates on trials

The recently-concluded 2021 ASCO Annual Meeting (ASCO21) featured numerous presentations on prostate cancer which caught the attention of our editorial board, as these presentations covered topics of interest at various stages of the disease. Albeit virtual, ASCO21 still delivered high-quality lectures and informative debates.

On localized prostate cancer, a few interesting papers highlighted the need for specific screening programmes (Qiao et al., 5004) and risk assessment tools (Yamoah et al., 5005) in the Afro-American population, who has a higher risk of getting the aggressive disease.

In the event of recurrence after local treatment, the usefulness of PSMA PET-CT was underlined as it clearly guides the changes in treatment in two thirds of the cases compared to conventional imaging (Cerci et al., 5078; Kapoor et al., 5064). The oncological benefit needs to be confirmed in long-term studies with a design comparable to the recently published EMPIRE-1 trial.

Preliminary results from the abiraterone arm of the PEACE-1 trial were presented, which confirmed the efficacy of abiraterone acetate in patients with metastatic castration-sensitive prostate cancer (Fizazi et al. 5000, watch the interview with Prof. Fizazi), even with concomitant treatment with docetaxel and primary tumour radiotherapy, and without synergistic toxicity when treatments were combined. Impressive radiographic improvements in progression-free survival have been demonstrated and overall survival data are expected soon.

A post-hoc analysis of the enzalutamide ARCHES trial confirmed the benefit of an intensified hormonal regimen, even in the case of oligo-metastatic disease (Armstrong et al., 5071).

The results of the VISION trial were presented in a plenary session (Morris et al., LBA4, watch the interview with Dr. Sartor). This trial offers a new standard of care for patients with PSMA-positive metastatic castration-resistant prostate cancer (mCRPC) previously treated with at least two lines of new hormone agents and/or taxane therapy. This targeted lutetium-PSMA radioligand therapy improves overall survival compared to standard care.

In the context of a multiple choice of drugs, the ODENZA trial did not identify patients’ preference by comparing enzalutamide and darolutamide at the stage of castration resistance in a crossover trial (Colomba et al., 5046).

Finally, the analysis of bone events in the PEACE-3 trial reinforced the role of mCRPC stage bone-protecting agents for reducing the risk of fracture, in both arms of the trial (enzalutamide with or without radium-223) (Gillessen et al., 5002).