Docetaxel provides oncological benefits in the era of new-generation androgen receptor inhibitors - or is three a crowd?

Abstract

In recent years, several systemic therapies have been introduced for metastatic hormone-sensitive prostate cancer (mHSPC), including androgen deprivation therapy (ADT) combined with docetaxel (Doc) and/or new generation androgen receptor signaling inhibitors (ARSI).

Trials evaluating ADT + ARSI have consistently demonstrated an overall survival (OS) benefit for doublet therapy over ADT alone. Similarly, the STOPCaP meta-analysis showed an OS benefit in favour of ADT + Doc vs ADT alone.

ARSI, Doc, and ADT have different antitumour mechanisms, thus potentiating the effect of combination therapy. Two randomised trials showed that the addition of ARSI to ADT + Doc improves OS, especially for synchronous high-volume disease. However, the real question about triplet therapy remains unanswered: whether combining Doc with ARSI improves outcomes compared to ADT+ARSI. As there are no head-to-head comparisons, this narrative review aims to summarise the current evidence regarding triplet therapy vs doublet therapy including ADT+ ARSI.