ASCO/CCO issue new guidelines for advanced prostate cancer

(HealthDay)—Guidelines, issued jointly by the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO) in Canada, highlight recent advances in treating hormone-therapy-resistant advanced prostate cancer. The guidelines were published Sept. 8 in the Journal of Clinical Oncology.

The guidelines build upon prior ASCO/CCO recommendations that were based on a systematic review of 28 randomized clinical trials published between 1979 and 2004. Since 2004, an additional 28 randomized clinical trials that cover systemic therapies, including targeted therapies and immunotherapies, have been identified and inform the current recommendations.

The new guidelines include the following recommendations: Continue hormone-deprivation therapy indefinitely, either in drug or surgical form; offer patients one of three treatment options—abiraterone/prednisone, enzalutamide, or radium-223 (if cancer has spread to the bones)—in addition to hormone deprivation; when considering chemotherapy, docetaxel/prednisone should be an option, but side effects must be discussed; offer cabazitaxel to men whose disease worsens even if docetaxel has been tried, but discuss side effects; offer sipuleucel-T to men with no symptoms or minimal symptoms of cancer; offer mitoxantrone, but include a discussion of the drug's "limited clinical benefit and side effect risk." The experts also recommend that clinicians begin discussion of palliative care early on while discussing treatment options.

"We have seen unprecedented progress against advanced prostate cancer recently, with six new treatments approved in the last couple of years," Ethan Basch, M.D., co-chair of the ASCO/CCO panel, said in a news release from the two groups. "There are a lot of nuances about treatment selection in terms of disease stage and what prior therapies the patient received. We hope this guideline will help doctors and patients make informed treatment decisions."
Several panel members disclosed financial ties to the pharmaceutical industry.