PARP inhibitors in prostate cancer: Guidelines, who to test and the patient pathway

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Published: 5 Jun 2020
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Dr Neal Shore and Dr Elena Castro

Dr Neal Shore (Carolina Urologic Research Center, Myrtle Beach, USA) and Dr Elena Castro (Spanish National Cancer Research Center, Madrid, Spain) discuss the emerging and crucial field of genetic testing in prostate cancer.

Dr Castro begins the discussion by outlining the main recommendations for urologists and medical oncologists regarding testing for prostate cancer patients - with reference to the PROfound trial. She states that every patient with advanced disease should be tested for DDR alterations.

Dr Shore elaborates on this, by giving a brief overview of the results achieved in the PROfound trial and states that two PARP inhibitors, olaparib and rucaparib have recently been approved by the FDA to treat patients with HRR-gene mutated metastatic castration-resistant prostate cancer.

Dr Castro explains the differences between somatic and germline testing and the importance of both methods. Dr Shore reflects on his own experiences in his clinic, where routine germline and somatic testing is carried out in metastatic patients following the evolving NCCN recommendations.

However, Dr Castro also adds that most clinical guidelines currently do not include germline or somatic testing for DDR alterations, and believes these must be incorporated in light of the current evidence.

Dr Shore concludes by emphasising both testing methods should be actively implemented into routine clinical practice, to guide the use of PARP inhibitors which can delay progression and improve survival for these patients.

This programme has been supported by an unrestricted educational grant from AstraZeneca.