Metastatic prostate cancer has traditionally relied on chemotherapy, imposing substantial burdens on patients; recent non-chemotherapy strategies and targeted agents now offer fresh therapeutic avenues.
Clinicians managing metastatic castration-sensitive prostate cancer (mCSPC) face a critical need for treatments that maintain disease control without the systemic toxicity of cytotoxic regimens. The recent FDA approval of darolutamide for mCSPC marks a pivotal shift, recommending its use in combination with ADT and docetaxel, as studied in the ARASENS trial.
Earlier findings from the ARASENS trial showed that darolutamide, in combination with ADT and docetaxel, significantly prolongs progression-free and overall survival in mCSPC, reducing the risk of death by 32.5% compared to ADT and docetaxel alone.
Despite these advances, metastatic castration-resistant prostate cancer (mCRPC) continues to challenge clinicians, as patients often exhaust standard hormonal and chemotherapeutic options. The ongoing phase 3 trial of ifinatamab deruxtecan for mCRPC is evaluating an antibody–drug conjugate against conventional chemotherapy regimens.
By comparing ifinatamab deruxtecan with established chemotherapy, investigators aim to determine whether this novel agent can extend survival and reduce adverse event profiles in a population resistant to existing therapies.
These developments could influence practice patterns: darolutamide’s approval provides an additional option for mCSPC management, and future research may reveal if ifinatamab deruxtecan offers a less toxic alternative for mCRPC. As these agents enter routine care, ongoing evaluation of long-term outcomes and exploration of patient subgroups will be essential to optimize sequencing and combination strategies.
Key Takeaways:- Darolutamide provides a non-chemotherapy option for mCSPC, improving patient quality of life.
- The ARANOTE trial was essential in demonstrating the efficacy of darolutamide without chemotherapy.
- Ifinatamab deruxtecan is a promising candidate for mCRPC, currently in phase 3 trials.
- Future treatment paradigms may shift as these therapies become integrated into clinical practice.