From the Guidelines
Nubeqa (darolutamide) is a recommended treatment option for stage IV, bone metastatic, castration-sensitive prostate cancer with a high Gleason score of 9 and PSA of 7.5, in combination with androgen deprivation therapy (ADT). The most recent guidelines from the National Comprehensive Cancer Network (NCCN) suggest that treatment intensification with ADT and additional therapies such as abiraterone, apalutamide, or enzalutamide is strongly recommended for patients with metastatic castration-sensitive prostate cancer 1.
Key Considerations
- The use of ADT monotherapy is discouraged unless there are clear contraindications to combination therapy 1.
- Nubeqa works by blocking the action of androgens (male hormones) that can stimulate cancer growth, while having a favorable side effect profile compared to some alternatives.
- Common side effects include fatigue, weakness, joint pain, and rash, which should be monitored regularly.
- Regular PSA testing (every 3 months initially) and imaging studies will be necessary to assess treatment response.
Treatment Approach
- The recommended regimen would be Nubeqa 600 mg (two 300 mg tablets) taken twice daily with food, combined with ADT such as leuprolide or degarelix injections.
- This combination therapy has shown significant benefits in extending survival and delaying disease progression in patients with metastatic castration-sensitive prostate cancer 1.
- It's essential to take Nubeqa consistently at the same times each day and to continue ADT without interruption.
- This treatment approach is particularly valuable for high-risk disease (indicated by a high Gleason score) and the presence of bone metastases, as it can help control disease spread while maintaining quality of life.
From the FDA Drug Label
NUBEQA is an androgen receptor inhibitor indicated for the treatment of adult patients with: • non-metastatic castration-resistant prostate cancer (nmCRPC). • metastatic hormone-sensitive prostate cancer (mHSPC) in combination with docetaxel.
The patient has stage IV prostate cancer with metastasis to bone, is castration sensitive, has a Gleason score of 9, and a PSA of 7.5. Based on the FDA label, NUBEQA is indicated for metastatic hormone-sensitive prostate cancer (mHSPC), which matches the patient's condition. However, the label specifies that NUBEQA is used in combination with docetaxel for mHSPC. Therefore, NUBEQA can be used to treat this patient's condition, but it should be used in combination with docetaxel 2.
From the Research
Treatment Options for Metastatic Castration-Sensitive Prostate Cancer
- The treatment landscape for metastatic castration-sensitive prostate cancer (mCSPC) has evolved rapidly over the past decade, with the addition of upfront intensification with novel hormonal therapies or docetaxel in addition to androgen deprivation therapy (ADT) 3.
- ADT is still the backbone of treatment, but the addition of docetaxel or abiraterone acetate has improved outcomes for patients with mCSPC and become standard of care 4.
- Treatment selection to optimize patient outcomes has become increasingly difficult, with multiple treatment options available for patients with mCSPC 4.
Role of Bone-Targeted Therapies
- Bone-targeted therapies, such as bisphosphonates and denosumab, are used to prevent skeletal-related events (SREs) in patients with metastatic castrate-resistant prostate cancer (mCRPC) 5.
- However, the use of bone-modifying agents (BMAs) in mCSPC may constitute overuse, as they are not recommended for this patient population 6.
- A retrospective cohort study found that over 25% of patients with mCSPC received BMAs, despite the lack of evidence supporting their use in this setting 6.
Treatment Patterns and Outcomes
- A retrospective cohort study using the Veterans Health Administration claims database found that most patients with mCSPC received ADT-only or ADT + nonsteroidal anti-androgen (NSAA), despite the emergence of docetaxel and novel hormonal therapies 7.
- Patients treated with ADT + NSAA had similar risks of castration-resistant disease and overall mortality as those treated with ADT-only 7.
- The study suggests that there is substantial room for improved outcomes in patients with mCSPC, with only 24% of men receiving intensified therapy with agents known to prolong survival versus ADT-only 7.
Nubeqa for Stage IV Metastatic Castration-Sensitive Prostate Cancer
- There is no direct evidence in the provided studies to support the use of Nubeqa for stage IV metastatic castration-sensitive prostate cancer with a Gleason score of 9 and PSA of 7.5.
- However, the studies suggest that treatment selection should be based on individual patient characteristics and treatment goals, and that novel hormonal therapies and docetaxel may be considered as part of the treatment regimen 4, 3.