Questions Around Precision Medicine for Prostate Cancer

Pedro C. Barata, MD, MSc, director, Clinical Genitourinary Medical Oncology Research Program, UH Seidman Cancer Center, and associate professor of Medicine, Section of Hematology and Medical Oncology at Case Western University, explains the unmet needs for prostate cancer precision medicine.

There are a number of targeted therapies for patients with prostate cancer and there is understanding of how to perform biomarker testing to determine eligibility for therapies. But, according to Barata, patient selection is still important question that oncologists are asking.

Determining which patients will do well on certain therapies will be a research focus, Barata hints. For example, homologous recombinant deficiency may correlate with response to immune checkpoint inhibitors, according to Barata and this needs to be evaluate in future studies.

Separately, Barata says that there should be exploration into the effectiveness of BiTE therapy and other targeted agents for patients with prostate cancer.

TRANSCRIPT:

0:08 | The secret here, I think, is how do we select our patients? We have no doubt prostate cancer is heterogenous. Therefore, we will find a subset of patients who will benefit from it. The question is how do we select those and the low hanging fruit? There’s mismatch repair deficient, Lynch, germline, or microsatellite instability in addition to high tumor mutational burden. However, that represents a very small fraction of the population of advanced prostate cancer, again 3% or so.

0:42 | I think in addition to that, there seems to be an association between patients who have, for example, certain normal recombinant deficient genes, and response to immune checkpoint inhibitors. So, that number can potentially be higher, and I’m thinking of CDK12, and others where immune checkpoint inhibitors seem to play a role. We have not cleared that up completely, but that's kind of where the field is going. And then a completely different scenario would be, you know, target immunotherapy therapies such as BiTE.