PARP Inhibitors in Prostate Cancer - Episode 16

Exciting Advances in the Therapeutic Space and Clinical Pearls for Treating Metastatic Prostate Cancer

Alicia Morgans, MD, MPH, lists several advances being made while treating metastatic prostate cancer and offers advice to clinicians who don’t see patients with the disease very often.

Matthew Fowler: Looking ahead into the future and at options that are seeking approval, what other exciting advances are being made in metastatic CRPC [castration-resistant prostate cancer]?

Alicia Morgans, MD, MPH: It’s extremely exciting right now for men with mCRPC [metastatic castration-resistant prostate cancer] in terms of the options that are opening for them. Radiopharmaceuticals are pushing the boundaries of how targeted we can be, and PSMA [prostate-specific membrane antigen]-targeted lutetium is probably going to be approved as a potential option in the next 6 months or so for men who have mCRPC that’s very heavily pretreated. If men can access the treatment, this will be a very effective option for them and will be incorporated with all of the other things that we have access to.

Also targeting PSMA with immunotherapies, antibody-drug conjugates, BiTE [bispecific T-cell engager] therapies, and TriKE [trispecific killer engagers] therapies are pushing the boundaries as well. Another direction that we’re going is targeting different proteins on the prostate cancer surface and inciting an immune response that sometimes is so effective or robust that patients need to be monitored in the hospital. There’s a lot coming and a lot shaking things up in mCRPC, and it’s quite an exciting time for us to see where we can go next and what combinations can be most effective.

One combination that was just reported in a press release is the combination of olaparib [Lynparza] plus abiraterone [Zytiga] in patients who have metastatic CRPC. We found they have a radiographic progression-free survival advantage with the combination of olaparib and abiraterone as compared with abiraterone alone. What was so interesting in this combination study is that benefit was occurring in patients who don’t have DNA repair defect mutations. Even men who didn’t have that mutation benefited from the combination of abiraterone and olaparib vs abiraterone alone, suggesting that abiraterone is somehow inducing a state where the olaparib could be effective. There’s so much that we’re learning and figuring out, and it’s only the beginning. There are advances coming one after the other. It’s quite a hopeful time for mCRPC.

Matthew Fowler: What clinical pearls, advice, or information do you have that you can share with colleagues who might not see patients with prostate cancer every day?

Alicia Morgans, MD, MPH: The best advice I have is to make sure that you’re doing the testing for these germline and somatic mutations, because if we don’t test, we won’t be able to find a patient who may benefit from these therapies. At the end of the day, it’s incumbent upon us to offer our patients every possible treatment that we can. Because if we can sequence treatment after treatment, we find that we can help men live longer and better, feeling well because their disease is controlled and because many of our treatments are much more tolerable than they could be. We’re able to support men and give them the treatments that they need. Doing the testing, getting patients the treatments that they need, and having that access and support is critical. That would be my best advice. Your listeners are probably already doing that, but it never hurts to hear it again.

Matthew Fowler: Absolutely. That’s a great point to end on. Dr Morgans, thank you so much for your time and insight. We really appreciate it.

Alicia Morgans, MD, MPH: Thank you for the opportunity. It was great to be here.

Matthew Fowler: Thank you all for watching this contemporary CancerNetwork® OncView program from MJH Life Sciences™. We hope you found this to be valuable to your clinical practice.

This transcript has been edited for clarity.