Mar 31, 2020

Prostate Cancer Update, Issue 1, 2020 — Part 1: Our interview with Dr Hussain highlights the following topics as well as cases from her practice:

• Case: A man in his early 60s with de novo oligometastatic prostate cancer (PC) receives an LHRH agonist and abiraterone/prednisone (00:00)
• Effect of preoperative hormonal therapy on shrinkage of the primary tumor (03:21)
• Benefit of local therapy in patients with metastatic PC (mPC) and low disease burden; surgery versus radiation therapy in the local management of PC (06:01)
• Rationale for adding secondary hormonal therapy or chemotherapy to androgen deprivation therapy (ADT) for patients with metastatic hormone-sensitive PC (mHSPC) (11:03)
• Results from the CHAARTED, GETUG-AFU15 and STAMPEDE trials establishing the efficacy of docetaxel in combination with ADT for mHSPC (14:05)
• Efficacy of secondary hormonal therapy in combination with ADT for mHSPC (17:09)
• Risks and benefits with secondary hormone therapy versus chemotherapy in combination with ADT for mHSPC (19:36)
• Tolerability of apalutamide versus enzalutamide (22:14)
• FDA breakthrough therapy designations for the PARP inhibitors olaparib, rucaparib and niraparib for metastatic castration-resistant PC (mCRPC) (23:35)
• Case: A man in his late 60s with mCRPC and a germline BRCA2 mutation receives olaparib with abiraterone/prednisone as first-line therapy on the NU 16U05 clinical trial (25:03)
• NU 16U05: A Phase II trial of olaparib or abiraterone alone or in combination as first-line therapy for patients with mCRPC and DNA repair defects (29:57)
• Spectrum of genetic alterations in PC (33:19)
• Genetic testing for patients with PC; somatic and germline testing for BRCA mutations (35:30)
• Rationale for cotargeting the androgen receptor and DNA repair pathways (39:53)
• Design and eligibility for the PROfound study evaluating olaparib versus enzalutamide or abiraterone in patients with mCRPC and homologous recombi nation repair gene alterations who experienced disease progression on prior hormonal therapy (43:43)
• Results of the PROfound study; improvement in radiographic progression-free survival and overall response rate with olaparib for men with mCRPC (47:23)
• Activity of abiraterone or enzalutamide for men with mCRPC in the second- or later-line setting (49:15)
• Duration of response to olaparib, rucaparib and niraparib in PC (51:38)
• Potential benefit with a PARP inhibitor in combination with secondary hormonal treatment versus either therapy alone in the up-front setting for patients with mCRPC and DNA repair defects (53:23)
• Role of platinum-based chemotherapy for patients with PC and DNA repair defects (56:05)
• Perspective on the potential role of olaparib, rucaparib and niraparib as maintenance therapy for patients with mPC and BRCA mutations (57:29)
• Clinical implications of the PROfound study results for the future use of olaparib for patients with mCRPC and DNA repair defects (59:01)
• Emerging data with olaparib, rucparib and niraparib for mCRPC      1h0m31s
• Molecular profiling for patients with PC (1:03:44)
• Optimal testing platform for genetic assessment (1:06:59)
• Results from a survey of medical oncologists regarding genetic testing in practice for patients with PC (1:08:30)
• Assessment of MSI status and NTRK fusions in practice (1:10:33)

CME information and select publications