Article ; Online: First-line combination treatment with PARP and androgen receptor-signaling inhibitors in HRR-deficient mCRPC: Applying clinical study findings to clinical practice in the United States.
2024 Volume 126, Page(s) 102726
Abstract: Introduction: Metastatic castration-resistant prostate cancer (mCRPC) remains incurable and develops from biochemically recurrent PC treated with androgen deprivation therapy (ADT) following definitive therapy for localized PC, or from metastatic ... ...
Abstract | Introduction: Metastatic castration-resistant prostate cancer (mCRPC) remains incurable and develops from biochemically recurrent PC treated with androgen deprivation therapy (ADT) following definitive therapy for localized PC, or from metastatic castration-sensitive PC (mCSPC). In the mCSPC setting, treatment intensification of ADT plus androgen receptor (AR)-signaling inhibitors (ARSIs), with or without chemotherapy, improves outcomes vs ADT alone. Despite multiple phase 3 trials demonstrating a survival benefit of treatment intensification in PC, there remains high use of ADT monotherapy in real-world clinical practice. Prior studies indicate that co-inhibition of AR and poly(ADP-ribose) polymerase (PARP) may result in enhanced benefit in treating tumors regardless of alterations in DNA damage response genes involved either directly or indirectly in homologous recombination repair (HRR). Three recent phase 3 studies evaluated the combination of a PARP inhibitor (PARPi) with an ARSI as first-line treatment for mCRPC: TALAPRO-2, talazoparib plus enzalutamide; PROpel, olaparib plus abiraterone acetate and prednisone (AAP); and MAGNITUDE, niraparib plus AAP. Results from these studies have led to the recent approval in the United States of talazoparib plus enzalutamide for the treatment of mCRPC with any HRR alteration, and of both olaparib and niraparib indicated in combination with AAP for the treatment of mCRPC with BRCA alterations. Summary: Here, we review the newly approved PARPi plus ARSI treatments within the context of the mCRPC treatment landscape, provide an overview of practical considerations for the combinations in clinical practice, highlight the importance of HRR testing, and discuss the benefits of treatment intensification for patients with mCRPC. |
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MeSH term(s) | Humans ; Poly(ADP-ribose) Polymerase Inhibitors/therapeutic use ; Prostatic Neoplasms, Castration-Resistant/drug therapy ; Prostatic Neoplasms, Castration-Resistant/pathology ; Prostatic Neoplasms, Castration-Resistant/genetics ; Male ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Androgen Receptor Antagonists/therapeutic use ; Nitriles/therapeutic use ; Piperazines/therapeutic use ; Piperazines/administration & dosage ; Phthalazines/therapeutic use ; Phenylthiohydantoin/therapeutic use ; Phenylthiohydantoin/analogs & derivatives ; United States ; Receptors, Androgen/genetics ; Benzamides/therapeutic use ; Piperidines/therapeutic use ; Indazoles/therapeutic use ; Signal Transduction/drug effects ; Recombinational DNA Repair/drug effects |
Chemical Substances | Poly(ADP-ribose) Polymerase Inhibitors ; Androgen Receptor Antagonists ; Nitriles ; Piperazines ; Phthalazines ; Phenylthiohydantoin (2010-15-3) ; enzalutamide (93T0T9GKNU) ; olaparib (WOH1JD9AR8) ; Receptors, Androgen ; Benzamides ; Piperidines ; Indazoles ; niraparib (HMC2H89N35) ; AR protein, human |
Language | English |
Publishing date | 2024-03-29 |
Publishing country | Netherlands |
Document type | Journal Article ; Review |
ZDB-ID | 125102-8 |
ISSN | 1532-1967 ; 0305-7372 |
ISSN (online) | 1532-1967 |
ISSN | 0305-7372 |
DOI | 10.1016/j.ctrv.2024.102726 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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