Prostate Cancer

Regimen Options

Last Updated: 06/03/2024 See Details

NOTE: LEUPROLIDE (LUPRON OR ELIGARD), TRIPTORELIN (TRELSTAR) IS ON PATHWAY.

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
Neoadjuvant/Adjuvant ± Radiation	leuprolide	Low	Low	NCCN Guidelines® for Prostate Cancer V.4.2023.
Metastatic Castrate-Sensitive (M1 disease) including High-Risk Castration-Sensitive Prostate Cancer	abiraterone and prednisone high-risk castrate-sensitive disease	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017. Fizazi et al. N Engl J Med 2017;377:352-60.
	abiraterone, prednisone, androgen-deprivation therapy (ADT) and docetaxel	Intermediate	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017. Fizazi K, et al. Lancet 2022; 399: 1695–07
	darolutamide, prednisone, androgen-deprivation therapy (ADT) and docetaxel	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.4.2023. Smith MR et al. N Engl J Med 2022; 386:1132-1142
	leuprolide	Low	Low	NCCN Guidelines® for Prostate Cancer V.4.2023. Schweizer MT, MD, et al. Cancer. 2013;119(20):3610-3618.
CASTRATE-RESISTANT/NON-METASTATIC
Non-metastatic Castrate-Resistant w/no radiographic metastases (M0 disease)	enzalutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Hussain et al. N Engl J Med 2018;378:2465-74
	enzalutamide and leuprolide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Hussain et al. N Engl J Med 2018;378:2465-74
	apalutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Smith et al. N Engl J Med 2018;378:1408-18
	apalutamide and leuprolide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Smith et al. N Engl J Med 2018;378:1408-18
	darolutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Wenzel M, et al. https://doi.org/10.1038/s41391-021-00395-4. Fizazi K et al. N Engl J Med . 2020 Sep 10;383(11):1040-1049.
	darolutamide and leuprolide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Wenzel M, et al. https://doi.org/10.1038/s41391-021-00395-4. Fizazi K et al. N Engl J Med . 2020 Sep 10;383(11):1040-1049.
	leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017.
CASTRATE-RESISTANT/METASTATIC
Initial or Subsequent Therapy	abiraterone and prednisone	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Ryan CJ, et al. N Engl J Med. 2013;368(2):138-48. Fizazi K, et al. Lancet Oncol. 2012;13(10):983-92.
	docetaxel and steroid	Intermediate	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Tannock IF, et al. N Engl J Med. 2004;351(15):1502-12. Berthold DR, et al. J Clin Oncol. 2008;26(2):242-5.
	enzalutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Scher HI, et al. N Engl J Med. 2012;367(13):1187-97. Beer TM, et al. N Engl J Med. 2014;371(5):424-33.
	apalutamide	Low	Low	NCCN Guidelines® for Prostate Cancer V.2.2017. Smith et al. N Engl J Med 2018;378:1408-18
	leuprolide	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017.
	cabazitaxel 20mg/m2 and steroid (third line)	Intermediate	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017. De Wit et al. N Engl J Med. 2019 Dec 26;381(26):2506-2518. a>. Eisenberger M et al. J Clin Oncol. 2017 Oct 1;35(28):3198-3206.
	olaparib (BRCA1/2)	Low	Low	NCCN Drugs & Biologics Compendium® Prostate Cancer V.2.2017. De Bono et al. N Engl J Med 2020; 382:2091-2102.
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care.
NEUROENDOCRINE METASTATIC
Initial or Subsequent Therapy	cisplatin and etoposide	Low	High	NCCN Guidelines® for Prostate Cancer V.2.2017. Ihde DC, et al. J Clin Oncol. 1994;12(10):2022-34. Sundstrom S, et al. J Clin Oncol. 2002;20(24):4665-72. NCCN Guidelines® for Small Cell Lung Cancer V.2.2017.
	carboplatin and etoposide	Low	High	NCCN Guidelines® for Prostate Cancer V.2.2017. Skarlos D, et al. Ann Oncol. 2001;12(9):1231-8. NCCN Guidelines® for Small Cell Lung Cancer V.2.2017.
	Best Supportive Care or Clinical Trial	NCCN Guidelines® for Supportive Care.

Neoadjuvant/Adjuvant ± Radiation

Evolent Pathways

leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Metastatic Castrate-Sensitive (M1 disease) including High-Risk Castration-Sensitive Prostate Cancer

Evolent Pathways

abiraterone and prednisone *high-risk castrate-sensitive disease*

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

abiraterone, prednisone, androgen-deprivation therapy (ADT) and docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

darolutamide, prednisone, androgen-deprivation therapy (ADT) and docetaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

CASTRATE-RESISTANT/NON-METASTATIC

Non-metastatic Castrate-Resistant w/no radiographic metastases (M0 disease)

Evolent Pathways

enzalutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

enzalutamide and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

apalutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

apalutamide and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

darolutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

darolutamide and leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

CASTRATE-RESISTANT/METASTATIC

Initial or Subsequent Therapy

Evolent Pathways

abiraterone and prednisone

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

docetaxel and steroid

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

enzalutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

apalutamide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

leuprolide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

cabazitaxel 20mg/m2 and steroid (third line)

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

olaparib (BRCA1/2)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

NEUROENDOCRINE METASTATIC

Initial or Subsequent Therapy

Evolent Pathways

cisplatin and etoposide

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and etoposide

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

Best Supportive Care or Clinical Trial

References

	Regimen	Alternative
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Any line of therapy	relugolix	Alternatives: leuprolide
Subsequent Therapy	sipuleucel-T	Alternatives: varies

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Any line of therapy

Regimen

** relugolix **

Subsequent Therapy

Regimen

** sipuleucel-T **

Pathways and Low-Value Regimens

Prostate Cancer