ALTHOUGH ARCHES was a positive trial, results may not signal a practice change at this time, according to formal discussant Ian Davis, MBBS (Hons), PhD, FRACP, FAChPM, Monash University Eastern Health Clinical School, Melbourne. “We should proceed with caution and probably not change practice yet,” he said.
“In order to change practice, a study should have a meaningful endpoint, the drug should have acceptable toxicity that does not compromise efficacy, and it should be cost-effective,” Dr. Davis said.
Evidence is mounting for a beneficial effect of adding several drugs to ADT earlier in the course of prostate cancer, including abiraterone, enzalutamide, and docetaxel.
“But current therapies work well and are cost-effective, so a high bar should be set for new treatments,” he said.
Dr. Davis noted that abiraterone acetate, docetaxel, enzalutamide, darolutamide, and apalutamide all have similar efficacy when added to ADT. “It may be time to do a comparative trial of all of these drugs and include determination of cost-effectiveness,” he said. ■
DISCLOSURE: Dr. Davis has received institutional research funding from Astellas Pharma, Roche/Genentech, MSD Oncology, AstraZeneca, Eisai, Pfizer, and Janssen Oncology; and patents/royalties/other intellectual property through Ludwig Institute for Cancer Research.