Prostate Cancer: 2021 ASCO Annual Meeting Highlights for the Advanced Practitioner: The Advanced Practitioner Perspective: Prostate Cancer: Abiraterone Acetate, Prednisone, and Radiotherapy in Metastatic Disease, By The ASCO Post Staff

Morgane C. Diven

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Karim Fizazi, MD, PhD, of Institut Gustave Roussy, discusses first results from the phase III PEACE-1 trial, which showed that abiraterone plus androgen-deprivation therapy and docetaxel improves radiographic progression-free survival in men with de novo metastatic prostate cancer. A transcript of his interview with The ASCO Post follows. PEACE-1 is a phase III trial that enrolled patients with metastatic prostate cancer. It had a 2 × 2 factorial design; one is whether we should add abiraterone on top of standard of care for these men with metastatic prostate cancer, and the second is whether we should use radiation therapy on top of standard of care. As you're well aware of, we've made major progresses in the past 5 years or so for men with de novo metastatic prostate cancer. Indeed, we've been able to demonstrate that adding docetaxel or abiraterone or other androgen receptor inhibitors, and/or radiation therapy to the prostate are all associated with clinical improvements in men, including overall survival benefit. The Advanced Practitioner Perspective :The PEACE-1 trial is a phase III study designed to evaluate the addition of abiraterone or radiation therapy to the standard of care treatment for men with de novo metastatic prostate cancer. The trial included almost 1,200 men in Europe, and standard of care changed over the duration of the study from androgen deprivation therapy (ADT) to ADT plus docetaxel. The randomization arms were standard of care alone, standard of care plus abiraterone and prednisone, standard of care with radiation therapy, or standard of care with abiraterone and radiation therapy. The data presented at ASCO 2021 reported on the co-primary endpoint of radiographic progression-free survival (PFS) for the abiraterone group. These data showed that the radiographic PFS was significantly improved in patients receiving abiraterone in addition to ADT and docetaxel, with or without radiation. Additionally, there was no interaction between abiraterone and radiation. The median time to radiographic PFS in the control arm (ADT + docetaxel) compared to abiraterone + standard of care was 2 years compared to 4.5 years. No additional toxicities were noted for the addition of abiraterone to docetaxel. It is important to note the order that treatment was initiated in patients who received ADT + doxetaxel + abiraterone with radiation therapy. Abiraterone was started during docetaxel therapy and radiation was started after docetaxel therapy was completed. This study will provide important information about combination therapy in the treatment of de novo metastatic prostate cancer. The patient characteristics will be important for evaluating the applicability of this study to the wider patient population. Additionally, it will be of interest to see what subsequent treatment options are for patients who progress on the ADT + docetaxel + abiraterone combination therapy.

Prostate Cancer: 2021 ASCO Annual Meeting Highlights for the Advanced Practitioner: The Advanced Practitioner Perspective: Prostate Cancer: Abiraterone Acetate, Prednisone, and Radiotherapy in Metastatic Disease, By The ASCO Post Staff

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