NCCN Guidelines Insights: Prostate Cancer, Version 1.2021

Featured Updates to the NCCN Guidelines

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  • 1 Robert H. Lurie Comprehensive Cancer Center of Northwestern University;
  • 2 Stanford Cancer Institute;
  • 3 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;
  • 4 Duke Cancer Institute;
  • 5 Abramson Cancer Center at the University of Pennsylvania;
  • 6 Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;
  • 7 Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center;
  • 8 Mayo Clinic Cancer Center;
  • 9 UT Southwestern Simmons Comprehensive Cancer Center;
  • 10 City of Hope National Cancer Center;
  • 11 Memorial Sloan Kettering Cancer Center;
  • 12 Prostate Health Education Network (PHEN);
  • 13 Fox Chase Cancer Center;
  • 14 Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;
  • 15 Roswell Park Comprehensive Cancer Center;
  • 16 University of Wisconsin Carbone Cancer Center;
  • 17 UC San Diego Moores Cancer Center;
  • 18 Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;
  • 19 O'Neal Comprehensive Cancer Center at UAB;
  • 20 Vanderbilt-Ingram Cancer Center;
  • 21 Moffitt Cancer Center;
  • 22 UCLA Jonsson Comprehensive Cancer Center;
  • 23 St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center;
  • 24 UCSF Helen Diller Family Comprehensive Cancer Center;
  • 25 University of California San Francisco Patient Services Committee Chair;
  • 26 The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;
  • 27 University of Michigan Rogel Cancer Center;
  • 28 Fred & Pamela Buffett Cancer Center;
  • 29 Huntsman Cancer Institute at the University of Utah; and
  • 30 National Comprehensive Cancer Network.
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The NCCN Guidelines for Prostate Cancer address staging and risk assessment after a prostate cancer diagnosis and include management options for localized, regional, and metastatic disease. Recommendations for disease monitoring and treatment of recurrent disease are also included. The NCCN Prostate Cancer Panel meets annually to reevaluate and update their recommendations based on new clinical data and input from within NCCN Member Institutions and from external entities. This article summarizes the panel’s discussions for the 2021 update of the guidelines with regard to systemic therapy for metastatic castration-resistant prostate cancer.

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    Fizazi K, Kramer G, Eymard JC, . Quality of life in patients with metastatic prostate cancer following treatment with cabazitaxel versus abiraterone or enzalutamide (CARD): an analysis of a randomised, multicentre, open-label, phase 4 study. Lancet Oncol 2020;21:15131525.

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    Loriot Y, Bianchini D, Ileana E, . Antitumour activity of abiraterone acetate against metastatic castration-resistant prostate cancer progressing after docetaxel and enzalutamide (MDV3100). Ann Oncol 2013;24:18071812.

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    Bianchini D, Lorente D, Rodriguez-Vida A, . Antitumour activity of enzalutamide (MDV3100) in patients with metastatic castration-resistant prostate cancer (CRPC) pre-treated with docetaxel and abiraterone. Eur J Cancer 2014;50:7884.

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    Smith MR, Saad F, Rathkopf DE, . Clinical outcomes from androgen signaling-directed therapy after treatment with abiraterone acetate and prednisone in patients with metastatic castration-resistant prostate cancer: post hoc analysis of COU-AA-302. Eur Urol 2017;72:1013.

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    Antonarakis ES, Lu C, Wang H, . AR-V7 and resistance to enzalutamide and abiraterone in prostate cancer. N Engl J Med 2014;371:10281038.

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    Scher HI, Lu D, Schreiber NA, . Association of AR-V7 on circulating tumor cells as a treatment-specific biomarker with outcomes and survival in castration-resistant prostate cancer. JAMA Oncol 2016;2:14411449.

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    Scher HI, Graf RP, Schreiber NA, . Assessment of the validity of nuclear-localized androgen receptor splice variant 7 in circulating tumor cells as a predictive biomarker for castration-resistant prostate cancer. JAMA Oncol 2018;4:11791186.

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    Armstrong AJ, Halabi S, Luo J, . Prospective multicenter validation of androgen receptor splice variant 7 and hormone therapy resistance in high-risk castration-resistant prostate cancer: the PROPHECY study. J Clin Oncol 2019;37:11201129.

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    Hussain M, Mateo J, Fizazi K, . Survival with olaparib in metastatic castration-resistant prostate cancer. N Engl J Med 2020;383:23452357.

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    Abida W, Campbell D, Patnaik A, . Non-BRCA DNA damage repair gene alterations and response to the PARP inhibitor rucaparib in metastatic castration-resistant prostate cancer: analysis from the phase II TRITON2 study. Clin Cancer Res 2020;26:24872496.

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    Corn PG, Heath EI, Zurita A, . Cabazitaxel plus carboplatin for the treatment of men with metastatic castration-resistant prostate cancers: a randomised, open-label, phase 1-2 trial. Lancet Oncol 2019;20:14321443.

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  • 57.

    Romero-Laorden N, Lozano R, Jayaram A, . Phase II pilot study of the prednisone to dexamethasone switch in metastatic castration-resistant prostate cancer (mCRPC) patients with limited progression on abiraterone plus prednisone (SWITCH study). Br J Cancer 2018;119:10521059.

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