Dr Tawagi on the Growing Role of Precision Medicine in Prostate Cancer

Overall, it’s great that we [have] a realm of precision oncology in prostate cancer, but we also need to make sure that it’s applicable to all of our patients…it’s important that we continue to identify other biomarkers and other tools within this field to help with treatment sequencing in mCRPC.”

Karine Tawagi, MD, assistant professor of medicine, Department of Medicine, Division of Hematology and Oncology, University of Illinois Chicago, College of Medicine, and University of Illinois Health, discusses the biomarker strategies, targeted therapies, and current clinical challenges in the management of metastatic castration-sensitive prostate cancer (mCSPC) and castration-resistant prostate cancer (mCRPC).

Although clinical trial populations may have included patients who received treatment with androgen deprivation therapy (ADT) alone in the mCSPC setting, real-world practice has shifted to the use of ADT in combination with androgen receptor pathway inhibitors (ARPIs), Tawagi begins. Therefore, patients who progress to mCRPC in the real-world generally have had exposure to a prior ARPI along with ADT, which creates a challenge in translating some clinical trial data for ARPIs in the mCRPC setting, she adds, noting that prior treatments can influence sequencing decisions.

The gap underscores the need to evaluate patients regarding potential eligibility for targeted therapies in the mCRPC setting, such as PARP inhibitors, Tawagi continues. However, Tawagi notes that approved PARP inhibitors in the mCRPC setting are indicated for patients harboring homologous recombination repair gene mutations in the case of olaparib (Lynparza) or BRCA mutations for rucaparib (Rubraca).

In regions like Chicago, where genetic diversity is high, the prevalence of such mutations may not be as significant, thereby limiting the applicability of this precision approach for a subset of patients, Tawagi explains. Therefore, continuing to explore additional biomarkers and potential targets for novel therapies remains a priority to develop more treatment options for a broader population of patients, she concludes.