Hormonal Combination Therapies for Prostate Cancer
- Combination therapy — pairing androgen deprivation therapy (also called hormone therapy) with FDA-approved oral agents — has become a widely used approach for treating metastatic prostate cancer, showing improved outcomes and extended survival.
- Abiraterone, enzalutamide, apalutamide, and darolutamide are key cancer drugs commonly paired with androgen deprivation therapy (ADT).
- These drugs work by disrupting androgen signaling — specifically testosterone, which often fuels prostate cancer growth. They offer similar effectiveness in slowing disease progression, with varying side effect profiles.
- “With a growing body of high-level evidence, we now know that initiating these combination-based approaches at the time of diagnosis leads to significantly longer survival for patients facing advanced disease,” Dr. Vivek Narayan, a medical oncologist at the University of Pennsylvania, tells SurvivorNet.
“Ultimately, what is now the current standard practice for the vast majority of patients with metastatic prostate cancer is the use of what we call combination approaches of androgen deprivation therapy,” Dr. Vivek Narayan, a medical oncologist at the University of Pennsylvania, tells SurvivorNet.
Hormone Therapy: The Backbone Of Treatment
Read More“I think it’s really important from that outset to emphasize … how it gets implemented, and which specific medicines they may choose,” he says.
Typically, patients start with androgen deprivation therapy, followed by the addition of one of several FDA-approved oral therapies a few weeks later. These drugs work by further disrupting androgen signaling, helping slow cancer progression.
The ‘Big Four’ Therapies
According to Dr. Narayan, four combination agents have shown strong clinical results when added to androgen deprivation therapy.
These include:
- Abiraterone: A hormone therapy that reduces testosterone production, often prescribed alongside prednisone, a steroid that helps manage treatment-related side effects
- Enzalutamide: An oral anti-androgen that blocks the effects of testosterone, commonly used in advanced prostate cancer treatment
- Apalutamide: Approved for metastatic castration-sensitive prostate cancer, this medication disrupts androgen signaling to slow cancer growth
- Darolutamide: A next-generation hormone therapy that prevents testosterone from binding to prostate cancer cells, helping to control disease progression
“There’s a lot of dealer’s choice… But what’s critical to me is not necessarily the drug that’s being chosen, but that it’s just being utilized in that early treatment setting,” Dr. Narayan explains.
While each drug has nuances — pill burden, dosing frequency, potential side effects — the overall efficacy across this group is considered highly comparable.
Risks vs. Benefits
In the ARCHES clinical trial — focused on prostate cancer patients undergoing androgen deprivation therapy (ADT) — research published in “Research and Reports in Urology” observed that some individuals treated with ADT combined with enzalutamide reported side effects including fatigue, high blood pressure, hot flashes, and cognitive or memory issues.
Still, Dr. Narayan emphasizes that using combination therapy early in the disease process offers significant benefits. Not only does it delay treatment resistance, but it also helps extend patient survival.
“Repeated studies … show that when we use these more combination-oriented approaches at the time of diagnosis … it ultimately translates into prolonged survival for patients with advanced prostate cancer,” he says.
Questions To Ask Your Doctor
- Why is a combination therapy being recommended for me?
- What can I expect regarding side effects?
- What can we do if side effects become too difficult?
- How will I be monitored while getting treatment?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.
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