ascopubs.org/doi/abs/10.120...

[edited below to the basics]

Background: The standard mCRPC treatment paradigm, with sequential single agents administered until resistance, may be limited due to heterogenous tumors comprised of clones differentially sensitive to available therapies. An alternative approach involves rapid cycling of non-cross resistant therapies in an attempt to efficiently eradicate sensitive clones, mitigate resistance, and minimize toxicity.

Methods: Patients with mCRPC received 3 consecutive treatment modules, each lasting 12 weeks. Upon completion of the 9-month study regimen, patients continued ADT alone.

Results: From 3/2017 to 11/2020, 40 mCRPC patients were enrolled. Of the patients with bone metastasis and elevated alkaline phosphatase levels at baseline , 78% had normalization of alkaline phosphatase upon completion of study regimen. Five of 31 patients (16%) were able to be maintained on ADT alone for over a year during the post-study surveillance period).

Conclusions: Treatment of mCRPC with a rapidly-cycling non-cross resistant regimen is feasible and a subset of patients achieve prolonged disease control on ADT alone after completion of study treatment. Rapid cycling of available CRPC therapies may eliminate castration-resistant clones in a subset of patients, a concept warranting further preclinical and clinical evaluation