The French journal of urology · 2025
Chemotherapy use in triplet approach for metastatic hormone-sensitive prostate cancer: French practice survey and expert opinion.
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Borchiellini Delphine, Gravis Gwenaelle, Gross Emmanuel, Hannoun-Levi Jean-Michel, Berdah Jean-François, Chapet Olivier, Chebbah Myriam, Le Clanche Solenn, Descotes Jean-Luc, Ruffion Alain, Maillet Denis, Pignot Géraldine
Аннотация
INTRODUCTION: Triplet therapy, combining androgen deprivation therapy (ADT) with docetaxel and either darolutamide or abiraterone/prednisone, has significantly improved outcomes in metastatic hormone-sensitive prostate cancer (mHSPC), especially in high-volume disease. However, the absence of standardized eligibility criteria for chemotherapy in current guidelines brings a challenge, potentially leading to underuse in appropriate patients. This study aimed to assess real-world clinical practices in France, evaluating the criteria guiding triplet therapy and leading to docetaxel chemotherapy exclusion.
MATERIAL AND METHODS: A national online survey was conducted between August 2023 and February 2024 among French urologists, radiation oncologists, and medical oncologists. Developed by a Steering Committee of 11 French experts, the questionnaire explored chemotherapy decision-making in mHSPC management. Responses were analyzed descriptively.
RESULTS: A total of 128 clinicians participated (59% urologists, 20% radiation oncologists, 21% medical oncologists). The primary criteria supporting triplet therapy included high metastatic burden (83%), high-volume disease (80%), and visceral metastases (77%). Conversely, chemotherapy exclusion was frequently based on ECOG Performance Status≥2 (87%), significant comorbidities (76%), advanced age (≥75) (65%), and a G8 score≤14 (51%). Responses varied across specialties.
DISCUSSION/CONCLUSION: This study highlights the need for standardized criteria to define which patients are considered fit for chemotherapy within a triplet therapy. As its use expands, it is crucial to establish both the disease profiles that justify treatment and the patient-related factors that may warrant withholding it. Integrating findings data with expert opinion can support equitable treatment decisions, avoid loss of opportunity, and ensure that the greatest number of eligible mHSPC patients can benefit from triplet therapy.
MATERIAL AND METHODS: A national online survey was conducted between August 2023 and February 2024 among French urologists, radiation oncologists, and medical oncologists. Developed by a Steering Committee of 11 French experts, the questionnaire explored chemotherapy decision-making in mHSPC management. Responses were analyzed descriptively.
RESULTS: A total of 128 clinicians participated (59% urologists, 20% radiation oncologists, 21% medical oncologists). The primary criteria supporting triplet therapy included high metastatic burden (83%), high-volume disease (80%), and visceral metastases (77%). Conversely, chemotherapy exclusion was frequently based on ECOG Performance Status≥2 (87%), significant comorbidities (76%), advanced age (≥75) (65%), and a G8 score≤14 (51%). Responses varied across specialties.
DISCUSSION/CONCLUSION: This study highlights the need for standardized criteria to define which patients are considered fit for chemotherapy within a triplet therapy. As its use expands, it is crucial to establish both the disease profiles that justify treatment and the patient-related factors that may warrant withholding it. Integrating findings data with expert opinion can support equitable treatment decisions, avoid loss of opportunity, and ensure that the greatest number of eligible mHSPC patients can benefit from triplet therapy.