For patients with high-volume hormone-sensitive prostate cancer, would you consider shortening the docetaxel course to 4 cycles to facilitate better tolerance?

My default here is always evidence-based medicine, in which 6 cycles of docetaxel were given as part of either concurrent triplet therapy (ARASENS or PEACE-1) or sequential triplet therapy (ARCHES, TITAN), without prednisone. For those who develop intolerance, a dose reduction or growth factor support would be my first intervention, but for those with neuropathy or non-heme toxicities who cannot tolerate dose reductions, early treatment cessation may be needed. For those men who have already ach...

ARASAFE trial- ADT+ Daro + Docetaxel randomization.

50 mg/m² on days 1 and 15 every 2 weeks vs 75 mg/m² every 3 weeks.

The experimental arm had a higher total docetaxel dose but lower grade 3–5 AEs.
Lower grade 3–4 neutropenia/death (NAER).
Significantly improved safety profile.

PSA ≤0.2 ng/mL at week 26: 49% (Q3W) vs 41% (Q2W).

OS pending.