Dr. Antonarakis on Therapeutic Agents for Select Patients With mCRPC

Emmanuel Antonarakis, MD, associate director for Translational Research, Clark Endowed Professor of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical School Masonic Cancer Center, discusses the different therapeutic agents that are available for patients with metastatic castration-resistant prostate cancer (mCRPC) who display either somatic or germline mutations. 

In this patient population, Antonarakis explained 2 classes of therapeutic agents utilized in prostate cancer: PARP inhibitors and PD-1 inhibitors.

The PARP inhibitors olaparib (Lynparza) and rucaparib (Rubraca) have been approved for patients with mCRPC. Olaparib has been approved for tumors with deleterious or suspected deleterious germline or somatic homologous recombination repair gene-mutated. Rucaparib is indicated for patients with germline or somatic BCRA1 and BRCA2 mutations, somewhat limiting its use in this patient population, Antonarakis notes.

Conversely, pembrolizumab (Keytruda) is indicated for use in patients with prostate cancer who display mismatch repair deficiency/microsatellite instability. These patients have highly immunogenic tumors, which in turn make them responsive to immune checkpoint inhibitors. Accordingly, pembrolizumab is an effective option for this patient population, Antonarakis concludes.