Updated NCCN Guidelines for Prostate Cancer: New Treatment Options Added
Posted: Friday, September 28, 2018
Several updates were recently made to the 2018 NCCN Clinical Practice Guidelines in Oncology® for Prostate Cancer. Revisions by the NCCN Prostate Cancer Guidelines Panel, chaired by James Mohler, MD, of the Roswell Park Comprehensive Cancer Center, Buffalo, New York, include the incorporation of the new, fine-particle formulation of the second-generation antiandrogen abiraterone into several treatment algorithms. The formulation was approved in combination with methylprednisolone by the U.S. Food and Drug Administration (FDA) in May 2018.
The combination of the new formulation of abiraterone plus methylprednisolone for treatment of metastatic castration-resistant prostate cancer was added to the treatment algorithm as a category 1 recommendation, indicating there is uniform NCCN consensus based upon high-level evidence. The option was also added for men with castration-naive disease with or without metastases as a category 2B recommendation, indicating there is NCCN consensus based upon lower-level evidence.
For men with high- and very high–risk disease with a life expectancy of at least 5 years, external-beam radiation therapy in conjunction with 2 to 3 years of androgen-deprivation therapy is now a category 1 recommendation, with the option of adding abiraterone plus methylprednisolone or prednisone. Androgen-deprivation therapy plus abiraterone and methylprednisolone was added as a category 2B recommendation.
The panel noted that an ongoing phase III study of enzalutamide in men with castration-resistant prostate cancer without metastases and a prostate-specific antigen (PSA) doubling time of up to 10 months found that enzalutamide improved metastasis-free survival over placebo. Based on these interim results, enzalutamide was added to the treatment algorithm as a category 1 recommendation. Apalutamide also has a category 1 ranking for this indication. Observation is still preferred for patients with a PSA doubling time of more than 10 months.
For the complete 2018 NCCN Guidelines for Prostate Cancer, see the link below (login required).
