Check for updatesInitial Management of NoncastrateAdvanced,Recurrent,or Metastatic ProstateCancer:ASCO Guideline UpdateKatherine S.Virgo,PhD,MBA';R.Bryan Rumble,MSc2;and James Talcott,MD,SM30BACKGROUNDchanges to the recommendations,were reviewed inIn 2021,ASCO updated a guideline on the initialdetail.Therefore,trials such as Systemic Therapy inmanagement of noncastrate recurrent,advanced,orAdvancing or Metastatic Prostate Cancer:Evaluation ofmetastatic prostate cancer.!Several recent develop-Drug Efficacy (STAMPEDE)Arm G (abiraterone),ments prompted this focused update.First,at the timeSWOG 1216 (orteronel),and the updated TITANof the 2021 update,the results from the ARASENS2(apalutamide)results are not discussed.trial were not yet available and darolutamide was not Thus,the current update is primarily driven by newyet US Food and Drug Administration-approved for clinical trial results comparing triplet therapies withpatients with noncastrate de novo metastatic prostate standard of care(SoC)as well as one meta-analysis ofcancer.However,on August 5,2022,darolutamide,in triplet therapy.5 Further informing this update is onecombination with docetaxel and androgen-deprivation network meta-analysis comparing ADT plus anan-therapy (ADT;triplet therapy),was US Food and Drug drogen receptor axis-targeted agent to ADT plusAdministration-approved for these patients based on docetaxel,a comparison not yet directly tested inthe results of the ARASENS trial2 and is one of several clinical trials but of great interestreasons an update was deemed necessary.See Data Supplement 6(online only):Included TrialsThe second major reason for a focused recommen-for a summary of included trials,Appendix Table Aldation update was publication of the results from the(online only)for all recommendations,including thosePEACE-1 trial of docetaxel plus abiraterone plus ADT that were not updated,Data Supplement 7:Table(triplet therapy)among patients with de novo meta-Comparing Original Recommendations with Updatedstatic noncastrate prostate cancer.Recommendations,and Figure 1 for a decision treeThe third reason for a focused recommendation up-depicting initial management of noncastrate meta-date was updated results from two enzalutamide trialsstatic prostate cancer.(ENZAMET4 and ARCHES5).The ENZAMET trial re-ASSOCIATEDMETHODSCONTENTleased (in abstract form only)updated survival resultsThis systematic review-based guideline product wasAppendixfor patients with metastatic noncastrate prostatecancer after three additional years of follow-up.4 Thesedeveloped by a multidisciplinary Expert Panel,whichData SupplementAuthor affiliationslonger-term results examine whether the previouslyincluded a patient representative and an ASCOreported early short-term survival benefits of enzalu-guidelines staff member with health research meth-and supportinformation (iftamide plus ADT (compared with bicalutamide,nilu-odology expertise.Evidence supporting unchangedapplicable)appeartamide,or flutamide
