Selecting doublet vs triplet therapy in mHSPC

Speaker: Prof. Giuseppe Luigi Banna

Short abstract:
This presentation explores systemic therapy options for metastatic hormone-sensitive prostate cancer (mHSPC), emphasizing the comparative efficacy and safety of doublet versus triplet regimens. It reviews key clinical trials, highlighting outcomes like overall survival and progression-free survival across diverse patient populations. The discussion includes considerations for treatment personalization based on disease volume and genomic biomarkers. Emerging imaging modalities and their impact on staging are also addressed, along with insights into future therapeutic strategies leveraging biomarker-driven approaches.

Educational outcomes – 3 points:

1. Improved Survival with Systemic Therapy Intensification: Clinical trials have demonstrated significant survival benefits from intensifying systemic therapy in mHSPC. Both doublet and triplet regimens, incorporating androgen deprivation therapy (ADT) with agents like docetaxel, darolutamide, abiraterone, apalutamide or enzalutamide, have shown enhanced overall survival and progression-free survival, especially in high-volume disease settings.

2. Role of Advanced Imaging in Staging: Next-generation imaging modalities, such as PSMA PET/CT and whole-body MRI, have led to stage migration by detecting metastases more accurately than conventional imaging methods. This improved staging impacts treatment decisions and may refine the identification of patients suitable for systemic or metastasis-directed therapies.

3. Personalised Treatment Strategies: Emerging approaches focus on tailoring therapy based on genomic biomarkers (e.g., BRCA mutations, PTEN loss) and patient characteristics like frailty or disease volume. These strategies aim to optimize treatment efficacy while minimizing toxicity, particularly in older or vulnerable populations.

Biography:

Giuseppe Luigi Banna is a Consultant Medical Oncologist specialising in Urology and Lung tumours. He currently holds positions at the Department of Oncology in Portsmouth Hospitals University NHS Trust and as an Honorary Associate Professor at the Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, UK.

He has led more than 20 clinical and translational studies for lung and urology cancer as Principal Investigator, collaborating with both commercial and academic research networks. His dedication to scientific advancement is reflected in his publication of more than 230 scientific papers in peer-reviewed and indexed journals.

His current scientific focus centers around the development of predictive models for immunotherapy, specifically those incorporating blood immune-inflammatory indexes. He also dedicates his efforts to projects aimed at assessing and monitoring adherence to anticancer oral treatments and creating tools to facilitate frailty assessment in oncology. His expertise extends to conducting systematic reviews, meta-analyses, and designing investigator-initiated studies with novel anticancer therapy combinations.

Ultimately, his professional objective is to provide each patient with the best-individualised treatment and support, further enhancing his reputation as a compassionate and skilled medical professional.