The future of PARP inhibitors in prostate cancer

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Published: 2 Jul 2020
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Dr Elena Castro - Spanish National Cancer Research Center, Madrid, Spain

Dr Elena Castro speaks to ecancer about her thoughts on the future of PARP inhibitors in prostate cancer, including possible treatment combinations and the potential role of these agents as an adjuvant therapy.

She states that patients with a BRCA2 mutation experience a very poor prognosis, and PARP inhibitors could be considered as a treatment option for earlier stages of the disease in the future.

Dr Castro emphasises that trials are needed to further characterise the role of PARP inhibitors in prostate cancer, and notes that there are trials underway that are exploring the combination of PARP inhibitors with checkpoint inhibitors, or androgen-receptor signalling inhibitors.

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

PARP inhibitors have demonstrated benefit in mCRPC as monotherapy both before and after taxane therapy when patients have progressed on either abiraterone or enzalutamide.

What are your thoughts about future trials and combinations of PARP inhibitors or moving these therapies earlier within prostate cancer treatment?

Definitely I think for patients with germline alterations we should try to use these PARP inhibitors earlier. I don’t know whether they could have any role as adjuvant treatment but we know from several studies that patients with germline BRCA2 mutations have a very poor prognosis. We now have this option of targeted therapies so definitely. I don’t know whether it should have to be in combination with something else or just in monotherapy or for how long. We need trials to address all these questions then we need to move PARP inhibitors to earlier stages. At least for these patients.

For combinations of PARP inhibitors there are plenty of clinical trials running at present combining different PARP inhibitors either with checkpoint inhibitors or with different androgen receptor signalling inhibitors for targeted populations, I mean patients with specific molecular alterations, or for all comers. It will be very interesting to see the results of all these trials.