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Prostate cancer highlights of the 2021 ESMO Annual Meeting

By Dr. Guillaume Ploussard (FR)

The recently concluded 2021 ESMO Annual Meeting featured numerous presentations on prostate cancer which caught the attention of our editorial board. With proven benefits from intensified therapy for prostate cancer patients, some presentations might lead to definitive changes in the clinical practice.

Abiraterone appeared once again as a game changer during this meeting. In a STAMPEDE trial update, Attard et al. presented the survival impact of this drug in M0 patients having either a node-positive disease or very high-risk features (at least two factors as follows: T3-T4 stage on MRI; Gleason score 8-10; PSA >40 ng/ml). In this cohort, two-year abiraterone provided a significant overall survival advantage compared with ADT alone or combined with radiotherapy.

As for patients with de novo M1 castration-sensitive disease, the results from the PEACE1 trial demonstrated that docetaxel in addition to ADT is not enough, and that a triplet combining these two drugs with abiraterone provides a significant advantage in terms of metastatic progression-free and overall survival, particularly in high-volume disease. Such a triplet (ADT + docetaxel + abiraterone) may become a first-line therapy option in high-volume, M1, newly diagnosed prostate cancer patients in the near future.

Three months after it had been featured at ASCO21 as well, the quality-of-life data from the VISION trial confirmed the good safety profile of targeted lutetium-PSMA radioligand therapy at a later stage in the treatment of mCRPC.

The efficacy and the safety of new-generation hormone therapies were highlighted in the long-term results of the ARAMIS trial and in the updated analysis of the ODENZA study, a patient preference trial assessing the cognitive impact of androgen receptor inhibitors in mCRPC patients. Preliminary data on the role of these drugs as maintenance therapy after chemotherapy were also presented, paving the way for an even wider use of new-generation hormone therapies in the future.