Second-Line Treatment Options in Advanced Prostate Cancer - Episode 4

Emerging Therapies for Metastatic Castration-Resistant Prostate Cancer

Robert Dreicer, MD, describes the future of metastatic castration-resistant prostate cancer.

Robert Dreicer, MD: I am often asked to sort of speculate where [I think] therapeutic management of mCRPC [metastatic castration-resistant prostate cancer] is going, and I think put simply it’s going to get complicated. It’s already complicated. It’s a very heterogeneous disease; we all understand that, because of the leftward earlier movement of the therapies we used for mCRPC, there are gaps. There are a number of drugs in the pipeline and there are a number of drugs that may see regulatory approval early in 2022, including lutetium177-PSMA-617. There are also PARP [poly adenosine diphosphate-ribose polymerase]/ARI [alpha reductase inhibitor] combinations for which level 1 evidence is forthcoming. We know that certain patients with DDR [DNA damage response and repair] mutations need to be targeted differently at least today, but the potential for “BRCA-ness,” or increasing synthetic lethality with a combination of a PARP and an ARI, may open up a very interesting time frame. There are other PSMA [prostate-specific membrane antigen] therapeutics coming, both in terms of radioactive materials including alpha particles, as well as a whole generation of PSMA-targeted immunomodulatory therapies—CAR [chimeric antigen receptor] Ts, biospecifics, etc. I think what we’re going to increasingly see is the segmentation hopefully based on some biomarker to begin to deliver different sequences to specific groups of patients going forward. We’re not there. We need better therapies, and again, at the end of the day, we’re not curing mCRPC, we need to move to a paradigm where that becomes an option for a subset of patients as these therapies come online.

Transcript edited for clarity.