Dr. Agarwal on Drug Development in Metastatic Castration-Sensitive Prostate Cancer

Neeraj Agarwal, MD, associate professor of medicine, University of Utah School of Medicine; and director, Genitourinary Oncology Program, Oncology Division, co-leader, Urologic Oncology Multidisciplinary Program, associate director of Clinical Trials, Huntsman Cancer Institute, discusses the need for further drug development in metastatic castration-sensitive prostate cancer.

Apalutamide (Erleada) has shown improved radiographic progression-free survival (rPFS) and overall survival (OS) in patients with mCSPC; however, this agent is not a curative therapy. Additionally, other antiandrogens and chemotherapy only confer a modest OS benefit in the range of 3 months in these patients, says Agarwal. As such, the need for additional agents in this space has become apparent.

Among investigational treatments, immunotherapy seems to hold the most potential, adds Agarwal. Notably, immunotherapy drugs are known to improve survival without having a significant impact on quality of life. In addition to immunotherapy, PARP inhibitors may play a role in this space. At the 2019 ESMO Congress, data from the phase III PROfound trial showed that olaparib (Lynparza) led to improved rPFS in patients with DNA repair defects in their tumors.