While the gut instinct is that patients prefer daily pills over injections, this preference flips when the injection is highly infrequent. For chronic conditions, a quarterly shot (four per year) is often viewed as more convenient and favorable by patients than the burden of a daily oral medication, challenging conventional wisdom on administration routes.

After years of treatment intensification, a new focus in metastatic hormone-sensitive prostate cancer is de-escalation. Trials like ADREAM are evaluating planned treatment interruptions for patients with excellent responses, aiming to provide 'treatment-free intervals' that improve quality of life without sacrificing efficacy.

After years of successfully intensifying hormonal therapy, the focus in prostate cancer is shifting toward de-intensification. Researchers are exploring intermittent therapy for top responders and developing non-hormonal approaches like radioligands to spare patients the chronic, life-altering side effects of permanent castration.

Clinicians may counsel patients towards therapies with lower efficacy if the dosing schedule is more convenient (e.g., quarterly). The rationale is that a lack of response is evident quickly, allowing a rapid pivot to another treatment without losing significant time or risking progression.

Traditional non-inferiority trials for reducing treatment are difficult to fund and execute. A proposed paradigm shift is to use superiority trial designs, where the burden of proof is on demonstrating that a higher dose or longer duration of therapy is actually better than a de-escalated approach.

The ERA SAFE study found that a bi-weekly, lower-dose docetaxel regimen for triplet therapy significantly lowers grade 3-4 adverse events compared to the standard 3-week schedule. It reduced the risk of neutropenic fever from 5.5% to 1.7% while maintaining similar efficacy, offering a safer alternative for frail or vulnerable patients.

A major trial on a less-frequent dosing schedule for denosumab in patients with bone metastases is being presented in a breast cancer session because it included both patient populations. This highlights the need for oncologists to monitor key research outside their specialty, as practice-changing data can emerge from unexpected places.

Recent phase 3 trial data highlights a significant gap in care for metastatic castration-resistant prostate cancer (mCRPC). Despite clear guideline recommendations, only about half of patients in the trial received bone-targeted agents, exposing a concerning real-world trend of underutilization of standard-of-care supportive therapy.

For the ADC belantamab mafodotin, clinicians should not feel rigidly bound to the initial every-three-week schedule. Data shows that spreading doses out to every 8 or 12 weeks is a viable strategy, as most patients stabilize or even improve their depth of response despite holding the drug, allowing for better toxicity management.