Neeraj Agarwal, MD, of the University of Utah's Huntsman Cancer Institute, discusses ongoing trials of PARP inhibitors as first-line metastatic prostate cancer treatments.
Neeraj Agarwal, MD, of the University of Utah's Huntsman Cancer Institute, discusses the possibility of moving PARP inhibitors from the treatment of patients who have progressed on other therapies and bringing them into the first-line setting.
There is discussion of giving PARP inhibitors earlier in the course of treatment. What are your thoughts on this issue?
[As far as] moving PARP inhibitors from the late metastatic castrate-resistant prostate cancer setting to early on, there are 3 trials going on, which are testing PARP inhibitors in first-line metastatic CRPC setting. Right now, PARP inhibitors are approved for after patients have been treated with novel hormonal therapy in metastatic castrate-resistant prostate cancer, for olaparib and a novel hormonal therapy plus chemotherapy with docetaxel for rucaparib.
There are 3 trials which are going on including the TALAPRO-2 trial [NCT03395197], MAGNITUDE trial [NCT03748641] and the PROPEL trial [NCT03732820]. They are asking the question of whether PARP inhibitors may have a role in patients who are newly diagnosed castrate-resistant prostate cancer. Another trial has started in metastatic castration-sensitive prostate cancer—so again, moving the PARP inhibitors to more upfront settings in newly diagnosed patients with metastatic castration-sensitive prostate cancer. A trial has recently started known as the AMPLITUDE trial [NCT04497844]. And in that trial, hundreds of patients who are candidates for this trial, meaning they have to have DNA repair, gene-related defects in the cancer cells, will be randomized to abiraterone plus androgen deprivation therapy versus abiraterone plus androgen deprivation therapy plus niraparib. So this trial is just open to accrual in the metastatic castration-sensitive prostate cancer, and the only way to move these agents to upfront settings is to accrue on the trial. So awareness among the patients is very important, and the onus is on us now to recruit patients on these trials so that we can get results fast enough to make these drugs available for our patients early on.