NCCN Updates Guidelines for Prostate Cancer Treatment

08/27/18

The National Comprehensive Cancer Network (NCCN) has released updated guidelines for prostate cancer, including the addition of a combination therapy, systemic therapy for castration-resistant therapy, and a principle of androgen deprivation therapy.

A new, fine-particle formulation of abiraterone in combination with methylprednisolone is now recommended for the treatment of patients with N1 or M1 castration-naïve prostate cancer as well as M1 castration-resistant disease. The recommendations are category 2B and 2A, respectively.

Clarification was added to these designations: “Abiraterone should be given with concurrent steroid, either prednisone (5 mg) orally twice daily or methylprednisolone (4 mg) orally twice daily depending on the formulation of abiraterone used. Abiraterone with either steroid should not be given following progression on abiraterone with the other steroid.”

For patients in need of systemic therapy for M0 castration-resistant prostate cancer, enzalutamide is now listed as a treatment option. The therapy is especially recommended if PSADT is 10 or less months.

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In the section for principles of androgen deprivation therapy, a new bullet was added to the third page: “A phase III study of patients with M0 castration-resistant prostate cancer and a PSADT of 10 or less months showed enzalutamide (160 mg/day) improved the primary endpoint of metastasis-free survival over placebo (36.6 vs 14.7 months, respectively). No significant differences was seen in overall survival at the first interim analysis. Adverse events included falls and non-pathologic fractures (17% vs 8%, respectively), hypertension (12% vs 5%, respectively), major adverse cardiovascular events (5% vs 3%, respectively), and mental impairment disorders (5% vs 2%, respectively). Bone support should be used in patients receiving enzalutamide.”

The discussion section of the guideline has been updated to reflect the changes in the treatment algorithm.—Zachary Bessette