Medical oncologist Monica Chatwal, MD, of Moffitt Cancer Center, Tampa, Florida, commented on the take-home points from the ARASENS trial.

“The ARASENS trial continues to show a survival benefit for a triplet therapy approach in metastatic hormone-sensitive prostate cancer with androgen-deprivation therapy, chemotherapy [docetaxel], and darolutamide, with a 32.5% reduction in the risk of death. This was seen across all risk and volume subgroups [as defined by LATITUDE and CHAARTED criteria]. However, it is important to note that a majority of patients on this trial had de novo metastatic disease, and most had high-volume or high-risk disease, signifying a higher risk population in this study. A considerable percentage of patients also had visceral disease,” she said.

According to Dr. Chatwal, the results of this trial will help guide treatment selection. “This trial helps to further confirm the benefit of this new therapeutic option for patients with metastatic hormone-sensitive prostate cancer, and the FDA has now approved the combination of androgen-deprivation therapy, docetaxel, and darolutamide in metastatic hormone-sensitive prostate cancer based on these study results. Triplet therapy, though an aggressive strategy, may certainly benefit some patients over the cost of potential toxicities. In clinical practice, I would certainly favor this approach in de novo metastatic hormone-sensitive prostate cancer, particularly in younger patients or those with a good performance status who have high-volume/high-risk, visceral, or symptomatic disease,” she continued.

“Though these data show a benefit across all subgroups, I would probably still reconsider and hold on triplet therapy in patients with low-volume/low-risk disease, with the concern that the financial, physical, and emotional toxicities may outweigh the benefit,” Dr. Chatwal stated. 

DISCLOSURE: Dr. Chatwal has served on the speakers bureau of Merck.