Anis Hamid, MBBS, genitourinary oncology research fellow, Dana-Farber Cancer Institute, discusses potential combinations with docetaxel in metastatic hormone-sensitive prostate cancer (mHSPC) subtypes.

Patients with luminal B mHSPC appear to benefit from docetaxel, says Hamid.

However, it is not yet understood whether the luminal B and basal subtypes respond similarly to available hormonal therapies such as abiraterone acetate (Zytiga), enzalutamide (Xtandi), and apalutamide (Erleada) as classic mHSPC, explains Hamid.

These agents are being investigated in prospective clinical trials for this patient population, says Hamid.

Additionally, the RNA profiling data from those studies may shed light on the utility of hormonal therapy in these subtypes of mHSPC, concludes Hamid.

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Anis Hamid, MBBS, discusses potential combination with docetaxel in metastatic hormone-sensitive prostate cancer subtypes.

Dr. Hamid on Potential Combinations With Docetaxel in mHSPC Subtypes

Anis Hamid, MBBS, genitourinary oncology research fellow, Dana-Farber Cancer Institute, discusses next steps for precision medicine in metastatic hormone sensitive prostate cancer (mHSPC).

In terms of development of a more precise way of treating patients with mHSPC, the data available at this stage is just related to gene expression profiling, says Hamid. What the field really wants to know is other biological information, mainly what is happening with the tumor genomics, what the mutational characteristics of these tumors that might be affecting prognosis are, or the predictive effects hypothesized with certain genomic alterations. 

There are layers of biological information about genomics, such as epigenomics how DNA methylation may affect treatment response or prognosis. Investigators hope to integrate multiple layers of biological information across independent cohorts to get a multidimensional view of the biomarkers that might eventually guide precision care for patients with mHSPC, concludes Hamid.

Anis Hamid, MBBS, discusses next steps for precision medicine in metastatic hormone sensitive prostate cancer.

Dr. Hamid on Next Steps for Precision Medicine in mHSPC

Anis Hamid, MBBS, genitourinary oncology research fellow, Dana-Farber Cancer Institute, discusses the evolution of precision medicine in prostate cancer.

It is exciting to see precision medicine truly take hold in prostate cancer, says Hamid. Historically, clinically driven parameters such as volume of metastatic disease were used to indicate which subpopulations of patients benefit from chemotherapy versus those that do not. Now, the field can use biological parameters to guide more precise treatment decisions.

Precision medicine is becoming more apparent across oncology with the use of clinical information, biological information, and drug response information, among other things, concludes Hamid.

Dr. Hamid on the Evolution of Precision Medicine in Prostate Cancer

Anis Hamid, MBBS, genitourinary oncology research fellow, Dana-Farber Cancer Institute, discusses the hypothesis of predictive biomarkers for newly diagnosed metastatic hormone sensitive prostate cancer (mHSPC).

A correlative study of gene expression profiling data from the phase III CHAARTED trial identified varying benefits with numerous treatment strategies in patients with different subtypes of mHSPC. Results from the analysis suggest that this variance could provide the potential for tailoring treatment to a patient’s disease subtype.

The analysis has generated a lot of hypotheses and excitement in the space. The critical next steps for this research is to validate the findings in independent cohorts, says Hamid. When biomarkers are developed to choose or tailor therapies more precisely for patients, it’s crucial to select markers that have been proven and are reproducible independently, adds Hamid.

To this end, the study investigators have collaborated with other research groups who have worked on clinical trials that have run similar investigations in this disease space to perform similar RNA analyses to evaluate this hypothesis again, says Hamid. Although it is not quite ready for prime time, it is providing some initial insights into the biology of the disease.

Investigators want to further explore the disease biology, says Hamid. To this end, they have made some classifications about responses correlating with luminal or basal subtypes. However, more insight into other biological programs and other correlations in place are needed to better understand the chemotherapy sensitivity or insensitivity of these disease subtypes, concludes Hamid.

Anis Hamid, MBBS, discusses the hypothesis of predictive biomarkers for newly diagnosed metastatic hormone sensitive prostate cancer.

Dr. Hamid on the Exploration of Predictive Biomarkers in mHSPC Subtypes

Anis Hamid, MBBS, genitourinary oncology research fellow, Dana-Farber Cancer Institute, discusses the progression of therapy for metastatic prostate cancer.

The standard of care for patients with metastatic prostate cancer was androgen deprivation therapy, explains Hamid. The randomized phase III CHAARTED trial, which reported out about 6 years ago, showed that the addition of docetaxel given upon diagnosis significantly improves the survival of patients with newly diagnosed prostate cancer, says Hamid.

After the CHAARTED trial and other related trials, docetaxel became the standard treatment for patients with metastatic prostate cancer. Since then, a number of different treatments were introduced in a similar setting, including the hormonal therapies abiraterone acetate (Zytiga), enzalutamide (Xtandi), and apalutamide (Erleada), concludes Hamid.

Anis Hamid, MBBS, discusses the progression of therapy for metastatic prostate cancer.

Dr. Hamid on the Progression of Therapy for Metastatic Prostate Cancer

Anis Hamid, MBBS, genitourinary oncology research fellow, Dana-Farber Cancer Institute, discusses the potential predictive value of the luminal B subtype as a biomarker of response to docetaxel in patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC).

Luminal A, B, and basal subtypes each comprise approximately 30% of all localized nonmetastatic prostate cancer cases, says Hamid. The population included the phase III CHAARTED trial consisted largely of patients with luminal B and basal tumors. In a correlative study from the CHAARTED trial, investigators found that luminal B tumors were associated with a shorter survival on hormone therapy alone, but those with that subtype significantly benefited from up-front docetaxel, says Hamid.

Conversely, basal tumors were associated with a better prognosis compared with luminal B tumors. However, patients with basal tumors did not derive a significant benefit with up-front docetaxel, says Hamid. This research suggests that luminal B and basal subtypes have prognostic value and predictive potential, concludes Hamid.

Anis Hamid, MBBS

Articles

Dr. Hamid on Potential Combinations With Docetaxel in mHSPC Subtypes

Dr. Hamid on Next Steps for Precision Medicine in mHSPC

Dr. Hamid on the Evolution of Precision Medicine in Prostate Cancer

Dr. Hamid on the Exploration of Predictive Biomarkers in mHSPC Subtypes

Dr. Hamid on the Progression of Therapy for Metastatic Prostate Cancer

Dr. Hamid on a Potential Biomarker of Response to Docetaxel in mHSPC