In a short theoretical paper, a group of Italian researchers question the rationale for advanced PCa patients staying on standard ADT when they start on an antigen receptor targeting agent (i.e.,the ARTAs; abiraterone, enzalutamide, apalutamide and darolutamide). Their argument is built around the idea that, if bipolar androgen therapy (BAT) helps control PCa by cycling between testosterone and androgen suppression, then it may be similarly advantageous to come off of standard ADT agents, when one is on an ARTA agent.
This is an interesting idea, but it is well ahead of the clinical research. The ARTAs were initially introduced to treat the most advanced PCa and now, justified by data from a series of on-going clinical trials, they are being introduced earlier in the treatment progression. We simply do not have enough data on the long-term efficacy of ARTA monotherapy to know whether they will work better alone, specifically in terms of both long-term survival and patient quality of life. Presumably, the patient quality of life will be better. However, we don’t know about survival. That’s because it takes many years to collect long term survival data and most of drugs have not been around long enough to answer that question.
It also needs to be recognized that BAT is still quite experimental and about 1/3 of the patients in trails so far found that the protocol accelerated their disease.
What this says to us is not only do we need more long-term data on ARTAs when used in combination with other therapies, but we also need more long-term data on the efficacy of ARTAs used alone as either continuous or intermittent therapy.
To read the full paper, see: https://doi.org/10.1007/s12020-022-03166-w
Reference:
Caramella, I., Dalla Volta, A., Bergamini, M., Cosentini, D., Valcamonico, F., & Berruti, A. (2022). Maintenance of androgen deprivation therapy or testosterone supplementation in the management of castration-resistant prostate cancer: That is the question. Endocrine, https://doi.org/10.1007/s12020-022-03166-w