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Prostate Cancer Foundation White Paper on Combination Therapy for Metastatic Hormone-Sensitive Prostate Cancer

Carlsson, Sigrid V. LU ; Barata, Pedro C. ; Bryce, Alan H. ; George, Daniel J. ; Gillessen, Silke ; Loeb, Stacy ; Montgomery, Bruce ; Morris, David ; Riaz, Irbaz Bin and Palapattu, Ganesh , et al. (2025) In JCO Oncology Practice
Abstract

Despite several randomized controlled trials demonstrating the benefits of combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC), a significant treatment gap persists. This initiative by the Prostate Cancer Foundation (PCF) convened stakeholders from academia, community practices, industry, and patient advocacy groups to address critical challenges in mHSPC care. Expert discussions and a review of real-world evidence and metaanalyses informed the development of strategies to improve care delivery. Evaluation of the data from global registries, such as IRONMAN, and large community databases was used to assess treatment utilization patterns and disparities. Combination therapies with two agents—androgen... (More)

Despite several randomized controlled trials demonstrating the benefits of combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC), a significant treatment gap persists. This initiative by the Prostate Cancer Foundation (PCF) convened stakeholders from academia, community practices, industry, and patient advocacy groups to address critical challenges in mHSPC care. Expert discussions and a review of real-world evidence and metaanalyses informed the development of strategies to improve care delivery. Evaluation of the data from global registries, such as IRONMAN, and large community databases was used to assess treatment utilization patterns and disparities. Combination therapies with two agents—androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI)—or three agents—ADT 1 ARPI 1 docetaxel—demonstrate significant survival improvements while preserving quality of life for patients with mHSPC, yet adoption remains inconsistent. Of the eligible patients, 20%-60% remain undertreated, with geographic, financial, and systemic barriers contributing to inconsistencies in care. Younger, White, urban-dwelling patients with fewer comorbidities are more likely to receive combination treatment, highlighting disparities across populations. Meta-analyses identified a lack of standardization due to varying inclusion criteria and comparators across trials. Real-world evidence underscored disparities influenced by geographic location, practice type, and access to specialty care. Initiatives such as the PANTHER study highlight improved outcomes in Black patients treated with combination therapies, emphasizing the importance of including diverse populations in clinical trials. To bridge gaps in care, this initiative prioritizes awareness, standardization, and equitable access to evidence-based therapies. Proposed solutions include targeted knowledge dissemination strategies, development of educational resources, and advocacy for policy changes to promote guideline-concordant care. By leveraging collaborative efforts, organizations, including PCF, can contribute to enhancing survival outcomes and quality of life for all patients with mHSPC.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
JCO Oncology Practice
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:105005715853
  • pmid:40315399
ISSN
2688-1527
DOI
10.1200/OP-25-00050
language
English
LU publication?
yes
id
a9bfaf22-b378-40c7-90bc-c89808986909
date added to LUP
2025-10-01 11:55:18
date last changed
2025-10-01 12:46:01
@article{a9bfaf22-b378-40c7-90bc-c89808986909,
  abstract     = {{<p>Despite several randomized controlled trials demonstrating the benefits of combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC), a significant treatment gap persists. This initiative by the Prostate Cancer Foundation (PCF) convened stakeholders from academia, community practices, industry, and patient advocacy groups to address critical challenges in mHSPC care. Expert discussions and a review of real-world evidence and metaanalyses informed the development of strategies to improve care delivery. Evaluation of the data from global registries, such as IRONMAN, and large community databases was used to assess treatment utilization patterns and disparities. Combination therapies with two agents—androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI)—or three agents—ADT 1 ARPI 1 docetaxel—demonstrate significant survival improvements while preserving quality of life for patients with mHSPC, yet adoption remains inconsistent. Of the eligible patients, 20%-60% remain undertreated, with geographic, financial, and systemic barriers contributing to inconsistencies in care. Younger, White, urban-dwelling patients with fewer comorbidities are more likely to receive combination treatment, highlighting disparities across populations. Meta-analyses identified a lack of standardization due to varying inclusion criteria and comparators across trials. Real-world evidence underscored disparities influenced by geographic location, practice type, and access to specialty care. Initiatives such as the PANTHER study highlight improved outcomes in Black patients treated with combination therapies, emphasizing the importance of including diverse populations in clinical trials. To bridge gaps in care, this initiative prioritizes awareness, standardization, and equitable access to evidence-based therapies. Proposed solutions include targeted knowledge dissemination strategies, development of educational resources, and advocacy for policy changes to promote guideline-concordant care. By leveraging collaborative efforts, organizations, including PCF, can contribute to enhancing survival outcomes and quality of life for all patients with mHSPC.</p>}},
  author       = {{Carlsson, Sigrid V. and Barata, Pedro C. and Bryce, Alan H. and George, Daniel J. and Gillessen, Silke and Loeb, Stacy and Montgomery, Bruce and Morris, David and Riaz, Irbaz Bin and Palapattu, Ganesh and Schoen, Martin W. and Washington, Samuel L. and Cornell, Brad and Levine, Rebecca and Aggarwal, Pankaj and McGowan, Tracy and Cotter, Matthew and Thompson, Betty and Devgan, Geeta and Russell, David and Kuperman, Gaston and Lenero, Enrique and Iwata, Kenneth and Miyahira, Andrea K. and Soule, Howard R. and Carithers, Gina and Oh, William K. and Agarwal, Neeraj}},
  issn         = {{2688-1527}},
  language     = {{eng}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{JCO Oncology Practice}},
  title        = {{Prostate Cancer Foundation White Paper on Combination Therapy for Metastatic Hormone-Sensitive Prostate Cancer}},
  url          = {{http://dx.doi.org/10.1200/OP-25-00050}},
  doi          = {{10.1200/OP-25-00050}},
  year         = {{2025}},
}