Metastatic Prostate Cancer: Sorting Through the Treatment Maze
The message still needs to get out that metastatic castration-sensitive prostate cancer should be treated with both androgen-deprivation therapy (ADT) and either docetaxel or an androgen receptor pathway inhibitor. In spite of “overwhelming” support for ADT plus abiraterone/prednisone,...
Effect of Timing of Radiotherapy Relative to ADT on Overall Survival in Prostate Cancer
In a study reported in JAMA Oncology, Dee et al found that radiotherapy (RT) initiated at up to 6 months after the start of androgen-deprivation therapy (ADT) was not associated with poorer overall survival vs initiation before ADT in men with prostate cancer. The investigators observed that these...
BRCA Study: Clinic Is Saving Men’s Lives in Israel
Uriya, age 49, visits Israel’s Rabin Medical Center for a cancer screening. On the surface, he shows no signs of disease. However, results from a study by David Margel, MD, PhD, revealed Uriya is living with prostate cancer at an early yet curable stage. Uriya carries the BRCA gene. Rabin Medical...
Rucaparib in Metastatic Castration-Resistant Prostate Cancer With Deleterious BRCA Alterations
As reported in the Journal of Clinical Oncology by Abida and colleagues, the phase II TRITON2 trial has shown that rucaparib produces durable responses in patients with metastatic castration-resistant prostate cancer with deleterious BRCA1 or BRCA2 alterations. The trial supported the May 2020...
Classification of Prostate Cancer Using Tests for Small Noncoding RNAs in Urinary Exosomes
In a study reported in the Journal of Urology, Wang et al found that tests for small noncoding RNAs isolated from urinary exosomes accurately distinguished patients with vs without prostate cancer and patients with low- vs intermediate- or high-risk disease. Study Details The investigators...
TITAN Trial: Apalutamide Adds to Options for Men With Metastatic Hormone-Sensitive Prostate Cancer
Androgen-deprivation therapy has been, and remains, the standard of care for patients with metastatic prostate cancer. Patients are often surprised to learn that was all we would do to control their disease and sometimes asked why they would not receive chemotherapy, as for other cancers. I would...
Many Choices Now for Men With Metastatic Hormone-Sensitive Prostate Cancer: How to Decide?
Based on the recently published ENZAMET, ARCHES, and TITAN trials,1-3 we now have several choices of systemic combination therapies for men with metastatic hormone-sensitive prostate cancer. Today, men are faced with decisions of androgen-deprivation therapy alone or combinations with abiraterone,...
Enzalutamide Improves Survival vs Standard First-LineTreatment in Hormone-Sensitive Metastatic Prostate Cancer
As reported inThe New England Journal of Medicine by Ian D. Davis, MBBS, PhD, FRACP, FAChPM, of Monash University and Eastern Health in Melbourne, and colleagues, the phase III ENZAMET trial has shown that the androgen receptor inhibitor enzalutamide improved progression-free and overall survival...
Addition of Apalutamide to Androgen-Deprivation Therapy in Metastatic Castration-Sensitive Prostate Cancer
As reported in The New England Journal of Medicine by Kim N. Chi, MD, of BC Cancer and Vancouver Prostate Centre, and colleagues, the first analysis of the phase III TITAN trial has shown that the addition of apalutamide to androgen-deprivation therapy improved radiographic progression-free and...
Nonmetastatic Castration-Resistant Prostate Cancer
Nonmetastatic castration-resistant prostate cancer arises in the subset of men with biochemically recurrent disease (ie, rising prostate-specific antigen [PSA] level after definitive therapy in the absence of metastases) who develop PSA progression after chronic exposure to androgen-deprivation...
Phase III Study of AR Antagonist in Nonmetastatic Castration-Resistant Prostate Cancer
In the phase III ARAMIS trial reported in The New England Journal of Medicine,1 Karim Fizazi, MD, PhD, of the Institut Gustave Roussy, Universite Paris-Sud, Villejuif, France, and colleagues found that the androgen-receptor (AR) antagonist darolutamide significantly prolonged metastasis-free...
Novel Indications and New Drugs for Castration-Resistant or Castrate-Sensitive Prostate Cancer
The past year has witnessed the U.S. Food and Drug Administration (FDA) approval of a number of drugs for treatment of patients with metastatic castrate-resistant prostate cancer or castrate-sensitive prostate cancer. Castrate-Resistant Prostate Cancer Olaparib: On May 19, 2020, olaparib...
Phase II TRITON2 Study in Metastatic Castration-Resistant Prostate Cancer
The single-arm TRITON2 study demonstrated the efficacy of the poly (ADP-ribose) polymerase (PARP) inhibitor rucaparib in patients with metastatic castration-resistant prostate cancer.1,2 Results from the study (ClinicalTrials.gov identifier NCT02952534) led to the approval of rucaparib in this...
Final Analysis of the ARAMIS Trial in Men With Nonmetastatic Castration-Resistant Prostate Cancer
A year ago, initial results from the double-blind, multicenter, randomized phase III ARAMIS clinical trial evaluating the efficacy and safety of darolutamide, a structurally unique androgen-receptor antagonist, in men with nonmetastatic castration-resistant prostate cancer, were published in The...
Final Overall Survival Analysis of the PROSPER Trial in Nonmetastatic Castration-Resistant Prostate Cancer
In the final overall survival analysis of the phase III PROSPER trial reported at the ASCO20 Virtual Scientific Program1 and published in The New England Journal of Medicine,2 Cora N. Sternberg, MD, and colleagues found that enzalutamide plus androgen-deprivation therapy (ADT) significantly...
Androgen Deprivation With Oral Relugolix vs Leuprolide in Advanced Prostate Cancer: HERO Trial
As reported at the ASCO20 Virtual Scientific Program1 and in The New England Journal of Medicine2 by Neal D. Shore, MD, FACS, of Carolina Urologic Research Center, Myrtle Beach, South Carolina, and colleagues, the phase III HERO trial showed sustained castrate testosterone levels and lower risk of...
In Biochemically Recurrent Prostate Cancer, PSMA-Targeted PET/CT Imaging May Be Useful
Positron-emission tomography/computed tomography (PET/CT) imaging with the prostate-specific membrane antigen (PSMA)-targeted radiotracer fluorine F-18 DCFPyL (PyL) successfully identified areas of occult metastasis in men with biochemically recurrent metastatic castration-resistant prostate...
Lutetium-177–Labeled PSMA-617 Improves PSA Response in First Analysis From TheraP Trial in Metastatic Prostate Cancer
Initial results of the randomized phase II TheraP trial showed that therapy directed to prostate-specific membrane antigen (PSMA) with lutetium-177–labeled PSMA-617 (LuPSMA) significantly improved prostate-specific antigen (PSA) response compared with cabazitaxel in men with metastatic...
Genitourinary Oncology Highlights 2019–2020 Almanac
Over the past year, we have seen significant advances in the treatment of prostate, kidney, and urothelial cancers that will benefit patients now and in the future. We have learned about the final results of important clinical trials across multiple genitourinary cancers disease states leading to...
Does Adding Neoadjuvant Chemohormonal Therapy to Surgery in Patients With Localized High-Risk Prostate Cancer Improve Biochemical Progression–Free Survival?
As reported in the Journal of Clinical Oncology by Eastham et al, the phase III CALGB 90203/Alliance trial has shown no improvement in 3-year biochemical progression-free survival (BPFS) with the addition of neoadjuvant chemohormonal therapy to radical prostatectomy in patients with localized...
Pan-BET Bromodomain Inhibitor Plus Enzalutamide in Advanced Prostate Cancer
A new multi-institution, dose-determining clinical trial of a compound for patients with metastatic, castration-resistant prostate cancer showed the combination “demonstrated acceptable tolerability and potential efficacy,” reported Aggarwal et al in Clinical Cancer Research. The phase Ib/IIa study ...
Leading Organizations Release New Clinical Guideline on Advanced Prostate Cancer
The American Urological Association (AUA), American Society for Radiation Oncology (ASTRO), and Society of Urologic Oncology (SUO) recently announced a new clinical practice guideline for the diagnosis and treatment of advanced prostate cancer. Prostate cancer is one of the most commonly diagnosed...
EAU Virtual: EUPROMS Study Investigates Effect of Prostate Cancer Treatment on Quality of Life
Findings from the first international prostate cancer quality-of-life study showed that significant numbers of men treated for the disease are struggling with continence and sexual problems after treatment. Results suggest that any treatment apart from active surveillance may negatively affect...
SNMMI 2020: Role of PSMA PET/CT in the Management of Recurrent Prostate Cancer
New research outlines the role of prostate-specific membrane antigen (PSMA) positron-emission tomography/computed tomography (PET/CT) in the detection and management of recurrent disease in prostate cancer patients. In initial results from a multicenter trial assessing the impact of F-18 DCFPyL...
New Recommendations Offer Guidance for Clinicians and Patients on Genetic Testing for Prostate Cancer
An international panel of experts led by researchers and thought leaders at the Sidney Kimmel Cancer Center–Jefferson Health (SKCC) and the Department of Urology at Jefferson have published the first multidisciplinary, consensus-driven, prostate cancer genetic implementation framework for the...
Rucaparib in BRCA-Mutated Metastatic Castration-Resistant Prostate Cancer
On May 15, 2020, rucaparib was granted accelerated approval for the treatment of patients with deleterious BRCA mutation–associated (germline or somatic) metastatic castration-resistant prostate cancer who have been treated with androgen receptor–directed therapy and taxane-based chemotherapy.1,2...
Event-Free Survival as a Surrogate for Overall Survival in Patients With Localized Prostate Cancer Treated With Radiotherapy
In a study reported in the Journal of Clinical Oncology, Xie et al found that event-free survival including prostate-specific antigen biochemical failure as an event is not an adequate surrogate for overall survival in men receiving radiotherapy as primary therapy for localized prostate cancer....
Expert Point of View: Scott T. Tagawa, MD, MS
Discussant Scott T. Tagawa, MD, MS, of Weill Cornell Medicine, New York, agreed that prostate-specific membrane antigen (PSMA)-targeted positron-emission tomography (PET) is the wave of the future, but data on long-term outcomes are needed, he said. “We are all aware of the deficiencies of imaging ...
PSMA-Targeted PET/CT Imaging May Be Useful in Biochemically Recurrent Prostate Cancer
Positron-emission tomography/computed tomography (PET/CT) imaging with the prostate-specific membrane antigen (PSMA)-targeted radiotracer fluorine F-18 DCFPyL (PyL) successfully identified areas of occult metastasis in men with biochemically recurrent metastatic castration-resistant prostate...
FDA Pipeline: Agents for the Treatment of Prostate and Pancreatic Cancers, Marginal Zone Lymphoma
Recently, the U.S. Food and Drug Administration (FDA) granted Priority Review to relugolix for the treatment of advanced prostate cancer; Fast Track designation to a radioimmunotherapeutic treatment for marginal zone lymphoma; and Orphan Drug designation to a novel monoclonal antibody for...
Novel Androgen-Deprivation Therapy With Relugolix Causes Fewer Cardiac Events Than Leuprolide in Advanced Prostate Cancer
Men with prostate cancer on androgen-deprivation therapy are usually treated with leuprolide, a long-acting injectable luteinizing hormone-releasing hormone (LHRH) agonist requiring an every-3-month injection, but it may be possible for ADT to be delivered by a daily oral treatment, pending...
Olaparib for Homologous Recombination Repair Gene-Mutated Metastatic Castration-Resistant Prostate Cancer
On May 19, 2020, olaparib was approved for the treatment of adult patients with deleterious or suspected deleterious germline or somatic homologous recombination repair (HRR) gene-mutated metastatic castration-resistant prostate cancer who experienced disease progression after treatment with...
Expert Point of View: Scott T. Tagawa, MD, MS
Discussant Scott T. Tagawa, MD, MS, of Weill Cornell Medicine, New York, agreed that prostate-specific membrane antigen (PSMA)-targeted positron-emission tomography (PET) is the wave of the future, but data on long-term outcomes are needed, he said. “We are all aware of the deficiencies of imaging ...
Daniel P. Petrylak, MD, on Prostate Cancer: First-in-Human Study of ARV-110 Shows Antitumor Activity
Daniel P. Petrylak, MD, of the Yale Cancer Center, discusses early data on ARV-110, an androgen receptor proteolysis–targeting chimera degrader, demonstrating antitumor activity in metastatic castration-resistant prostate cancer after treatment with enzalutamide and abiraterone (Abstract 3500).
In Biochemically Recurrent Prostate Cancer, PSMA-Targeted PET/CT Imaging May Be Useful
Positron-emission tomography/computed tomography (PET/CT) imaging with the prostate-specific membrane antigen (PSMA)-targeted radiotracer fluorine F-18 DCFPyL (PyL) successfully identified areas of occult metastasis in men with biochemically recurrent metastatic castration-resistant prostate...
IMbassador250 Trial: No Survival Benefit With Atezolizumab and Enzalutamide in Metastatic Prostate Cancer
The addition of the checkpoint inhibitor atezolizumab to enzalutamide failed to improve overall survival compared with enzalutamide alone in men with metastatic castration-resistant prostate cancer in the phase III IMbassador250 trial, according to results presented at the 2020 American Association ...
PSA Level Prior to Salvage Radiotherapy: Tailoring Delivery of ADT to Men With Prostate Cancer Most Likely to Benefit
In a recent article in JAMA Oncology, reviewed in this issue of The ASCO Post, Dess et al present an important analysis to help guide decision-making in the setting of salvage radiotherapy in prostate cancer.1 This secondary analysis assessed the association of prostate-specific antigen (PSA)...
Presalvage Radiotherapy PSA Levels and Outcomes With Long-Term Antiandrogen Therapy in Prostate Cancer
In an analysis from the NRG/RTOG 9601 trial reported in JAMA Oncology,1Robert T. Dess, MD, of the Department of Radiation Oncology, University of Michigan, Ann Arbor, and colleagues found that men with higher prostate-specific antigen (PSA) presalvage radiotherapy levels after prostatectomy had a...
Men of Color Remain Underrepresented in Prostate Cancer Clinical Trials
An analysis of 59 prostate cancer clinical trials based in North America and Europe found that the vast majority of enrollees were non-Hispanic white men, according to a study published by Rencsok et al in Cancer Epidemiology, Biomarkers & Prevention. The proportion of white participants in...
Expert Point of View: Scott T. Tagawa, MD, MS
Discussant Scott T. Tagawa, MD, MS, of Weill Cornell Medicine, New York, congratulated Dr. Hofman and coauthors on this first randomized trial any PSMA-targeted therapy, and was cautiously optimistic about the targeted radioligand treatment being adopted as post-docetaxel therapy in men with...
Lutetium-177–Labeled PSMA-617 Improves PSA Response in First Analysis From TheraP Trial in Metastatic Prostate Cancer
Initial results of the randomized phase II TheraP trial show that therapy directed to prostate-specific membrane antigen (PSMA) with lutetium-177–labeled PSMA-617 (LuPSMA) significantly improved prostate-specific antigen (PSA) response compared with cabazitaxel in men with metastatic...
Michael J. Morris, MD, on Prostate Cancer: Impact of PSMA-Targeted Imaging on Clinical Management
Michael J. Morris, MD, of Memorial Sloan Kettering Cancer Center, discusses phase III data from the CONDOR trial, which showed that PSMA-targeted PET scans detected and localized occult disease in most men with biochemically recurrent prostate cancer presenting with negative or equivocal conventional imaging findings (Abstract 5501).
Androgen Deprivation With Oral Relugolix vs Leuprolide in Advanced Prostate Cancer: HERO Trial
As reported at the ASCO20 Virtual Scientific Program (Abstract 5602) and in The New England Journal of Medicine by Shore et al, the phase III HERO trial showed sustained castrate testosterone levels and lower risk of major cardiovascular events with the oral gonadotropin-releasing hormone...
Neal D. Shore, MD, on Prostate Cancer: Relugolix vs Leuprolide for Advanced Disease
Neal D. Shore, MD, of the Carolina Urologic Research Center, discusses phase III results of the HERO study, which showed relugolix achieved castration as early as day 4 and was superior to leuprolide in sustained testosterone suppression, testosterone recovery after discontinuation, and reduction in cardiovascular side effects (Abstract 5602).
Final Overall Survival Analysis of the PROSPER Trial in Nonmetastatic Castration-Resistant Prostate Cancer
In the final overall survival analysis of the phase III PROSPER trial reported at the ASCO20 Virtual Scientific Program (Abstract 5515) and published in The New England Journal of Medicine, Cora N. Sternberg, MD, and colleagues found that enzalutamide plus androgen-deprivation therapy (ADT)...
Rana R. McKay, MD, on Prostate Cancer: Intense Androgen-Deprivation Therapy Before Radical Prostatectomy
Rana R. McKay, MD, of the University of California, San Diego, discusses the results of a phase II trial of intense neoadjuvant hormone therapy followed by radical prostatectomy in men with high-risk prostate cancer. The data show that 21% of patients had a favorable pathologic response (Abstract 5503).
Expert in Clinical Trial Methodology Makes His Mark in Genitourinary Cancer
In 2019, at the ASCO Annual Meeting, Ian Tannock, MD, PhD, DSc, FASCO, was honored with the Allen S. Lichter Visionary Award for his contributions to the fields of genitourinary and breast cancers as well as his efforts to optimize clinical trial design. The title of his lecture was “Clinical...
David R. Wise, MD, PhD, on Novel Biomarkers in Prostate Cancer: Is Tissue the Issue?
David R. Wise, MD, PhD, of New York University Perlmutter Cancer Center, summarizes three important studies in prostate cancer: circulating tumor cell count as a prognostic marker of PSA response and progression in metastatic castration-sensitive disease; new phenotypic subtypes; and how circulating tumor DNA dynamics associate with treatment response and radiologic progression-free survival (Abstracts 5506, 5507, and 5508).
Michael S. Hofman, MBBS, on Prostate Cancer: LuPSMA vs Cabazitaxel in Metastatic Castration-Resistant Disease
Michael S. Hofman, MBBS, of the Peter MacCallum Cancer Centre, discusses phase II results from the ANZUP 1603 trial, which showed that in men with docetaxel-treated metastatic castration-resistant prostate cancer, LuPSMA was more active than cabazitaxel, with relatively fewer grade 3 and 4 adverse events and a more favorable PSA progression-free-survival (Abstract 5500).
Data From TAPUR Study Cohorts on Olaparib for BRCA-Mutated Advanced Prostate and Pancreatic Cancers
Positive results from two cohorts of the Targeted Agent and Profiling Utilization Registry (TAPUR) study provide real-world evidence to support recent clinical trial data that demonstrate a role for olaparib in the treatment of advanced prostate and pancreatic cancers with BRCA1/2-inactivating...
