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NCCN Trends™ Highlights: Metastatic Castration-Resistant Prostate Cancer and Sequence of Therapy

By Sherry L. Ulrich, MBA, Market Insights Specialist, NCCN

It is estimated by the National Cancer Institute that there will be approximately 221,000 new cases of prostate cancer in 2015, representing 13% of all new cancers and making it the third most common type of cancer in the United States. Although better screening and treatments have improved outcomes, some patients progress to develop metastatic disease.i

Previously, only docetaxel was available to patients with metastatic castration-resistant prostate cancer (mCRPC) as a first-line standard of care. However, in recent years, a number of options, including, but not limited to immunotherapy, hormonal therapy, and radionuclide therapy, have emerged for the treatment/management of mCRPC.ii These treatment options have various mechanistic pathways and are providing beneficial first-, second-, and third-line therapeutic options.ii,iii 

In November 2014, the National Comprehensive Cancer Network® (NCCN®) conducted an NCCN Trends™ survey about mCRPC and asked participants how they anticipated the use of mCRPC therapies such as abiraterone, enzalutamide, radium Ra223 dichloride, and sipuleucel-T to change. With the exception of sipuleucel-T, the majority of respondents expected that there would be no change, or the use would increase for each of the therapies.


Overall, how do you expect the use of the following therapies to treat chemo-naïve patients with mCRPC to change within the next 12 months? (Select one per row)

With the addition of any new therapy options, clinicians face new challenges, such as sequencing of agents. Because current data are not able to inform the optimum sequencing of therapies in order to maximize effectiveness, choices may be based on cost, patient preferences, symptoms, prior treatment, and other clinical considerations.iv,v 

Survey respondents were also given a list of therapy sequences and asked which they would use in the chemo-naïve mCRPC setting. At 31 percent, the top response was “abiraterone then docetaxel,” followed by “abiraterone then enzalutamide” at 25 percent.


Typically in what order would you use the following sequences in the chemo-naïve mCRPC setting? (n = 340)

In summary, although patients with prostate cancer are living longer, metastatic disease continues to present challenges both to the patient and his clinicians. Depending on the presence or absence of symptoms, as well as other factors – clinical and non-clinical – patients with mCRPC and their clinicians now have, in addition to docetaxel, multiple first-line therapeutic options available to them. In order to reach the next level and maximize the use of these new and emerging treatment options, timing and sequencing must be established.ii,v


Additional Resources:

The National Comprehensive Cancer Network® (NCCN®) has published the first NCCN Quick Guide™ for Prostate Cancer. This resource summarizes key points of the NCCN Guidelines for Patients®: Prostate Cancer, Version 2015, which was published earlier this month. Key points include recommendations for initial and subsequent treatment and suggestions for the decision-making process.

The NCCN Guidelines for Patients® and NCCN Quick Guide™ for Prostate Cancer provide the same current and accurate cancer information on health care options that clinicians access in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®).

A digital version of the NCCN Quick Guide™ for Prostate Cancer is available free-of-charge on

NCCN currently offers NCCN Guidelines for Patients for the following: Breast Cancer: Stages 0-IV; Colon, Esophageal, Non-Small Cell Lung, Ovarian, Pancreatic, and Prostate Cancers; Acute Lymphoblastic Leukemia; Caring for Adolescents and Young Adults (AYA); Chronic Myelogenous Leukemia; Malignant Pleural Mesothelioma; Melanoma; Multiple Myeloma; Lung Cancer Screening; and Soft Tissue Sarcoma. NCCN Quick Guide™ sheets are currently available for Stage IV Breast and Prostate Cancers, as well as Lung Cancer Screening.

NCCN is committed to developing a comprehensive patient library with support from the NCCN Foundation®.

For additional information, please visit:


NCCN Trends Surveys & Data

NCCN Trends is a survey-based analytics tool from NCCN that focuses on how clinicians in the United States and abroad deliver cancer care. NCCN Trends Surveys pose questions regarding topics including, but not limited to, patterns of care and awareness and utilization of various treatment modalities, as well as key topics impacting oncology stakeholders, such as how changes in the health care environment impact them and their patients.

Data is gathered through brief electronic surveys to more than 154,000 health care providers who access on a frequent basis and express interest in responding to NCCN Trends Surveys. These clinicians consist of practicing physicians in diverse practice settings, including academic/research cancer centers, community hospitals, and private practices. Survey participants also represent pharmacists, nurses, and other oncology stakeholders. In 2014, NCCN conducted 12 NCCN Trends Surveys, averaging more than 900 clinician respondents per survey.

NCCN TrendsSurveys and Data are independent of any NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) or other NCCN clinical recommendations.

[i] "Surveillance, Epidemiology, and End Results Program Turning Cancer Data Into Discovery." Cancer of the Prostate.  Accessed June 3, 2015.

[ii] Saad, F, and Heinrich, D. "New Therapeutic Options for Castration-resistant Prostate Cancer." The Journal of Oncopathology.  2013;1(4):23-32.

[iii] Doctor, SM, Tsao, C, Godbold, JH, et al.  “Is Prostate Cancer Changing?  Evolving Patterns of Metastatic Castration-Resistant Prostate Cancer.”  Cancer.  2014:833-839.

[iv] National Comprehensive Cancer Network®, NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®); Prostate Cancer, Version 1.2015.

[v] Parente, P, Parnis, F, Gurney, H.  “Challenges in the sequencing of therapies for the management of metastatic castration-resistant prostate cancer.” Asia-Pacific Journal of Clinical Oncology. 2014;10:205-215.