The Targeted Pulse: Apalutamide Provides a Faster, Deeper PSA Response vs Enzalutamide, Vorasidenib Receives Approval in Glioma, and More

Want to test your knowledge on the latest oncology news? Check out this week’s quiz!

Apalutamide Leads to Faster, Deeper PSA Response Vs Enzalutamide in mCSPC

Real-world data showed that apalutamide (Erleada) demonstrated a quicker and deeper prostate-specific antigen (PSA) response vs enzalutamide (Xtandi) in patients with metastatic castration-sensitive prostate cancer (mCSPC). The study included patients who had no prior therapy with an androgen receptor synthesis inhibitor and investigators evaluated the deep PSA response defined as a 90% or greater PSA decline.

“These data help me feel confident that apalutamide would be a strong option for most of our patients...A lot of times, there might be other reasons, including drug interactions, coverage, and other things that can get in the way with some of the treatments,” Benjamin H. Lowentritt, MD, FACS, explained. “But these kind of data certainly does help me feel confident that for many of my patients [with mCSPC], and maybe most of my patients now in this situation, apalutamide can be expected to have the best possible outcome from a PSA response.” Lowentritt is director, minimally invasive surgery and robotics and the prostate cancer care program at Chesapeake Urology Baltimore, Maryland.

Combination Therapy is Taking Center Stage in Myelofibrosis Treatment

In the phase 1/3 SENTRY study (NCT04562389), investigators evaluate the combination of selinexor (Xpovio) plus ruxolitinib (Jakafi) in patients with myelofibrosis who have had no prior treatment with a JAK inhibitor. John Mascarenhas, MD, professor of medicine, Icahn School of Medicine, Mount Sinai; director, Center of Excellence for Blood Cancers and Myeloid Disorders; and member, The Tisch Cancer Institute, Mount Sinai, explains the rationale behind the study and how it could shift the treatment field towards combination therapy as standard of care in myelofibrosis treatment.

“We are moving to an era where combination therapy is likely going to be the standard of care, but not yet. We do not have an approved combination of a JAK inhibitor plus a novel agent,” Mascarenhas explained. “I will also mention that ruxolitinib has been explored in combination with interferon alfa-2a and -2b, so that is another approach that has been evaluated in earlier phase studies. This is the natural evolution of therapeutic advancement in this space.”

Managing Anxiety and Depression in Cancer with Integrative Care

Integrative oncology includes a holistic approach combined with conventional medical care. It incorporates therapies from traditional practices, such as Chinese medicine, Arabic medicine, and other culturally-based treatments, alongside evidence-based complementary therapies like acupuncture and aromatherapy. The result has shown to reduce adverse events (AEs) including anxiety and depression for individuals with cancer. Guidelines have been developed to include integrative oncology; however, challenges in availability and insurance coverage impede the wider adoption of this valuable approach.

“This guideline adds value in the sense that many patients are interested in integrative therapies but do not realize there is a strong evidence base for many of these therapies,” Richard Lee, MD said. Lee is clinical professor and director’s chair of the Cherng Family Center for Integrative Oncology at City of Hope in the Department of Supportive Care Medicine and Medical Oncology.

FDA Makes Way for Vorasidenib With an Approval for IDH-Mutant Diffuse Glioma

The FDA has approved vorasidenib (Voranigo, formerly AG-881) for the treatment of IDH-mutant diffuse glioma. This approval is based on data from the phase 3 INDIGO trial (NCT04164901), which compared the oral agent with placebo and showed improved progression-free survival (PFS) and a delayed time to next intervention. Vorasidenib is the first of its kind approved for IDH-mutant gliomas and represents Servier’s sixth approval for therapies targeting cancers with IDH mutations.

“What’s exciting is this is a development that we haven’t seen in over 20 years, and what we found is that when we looked at our patients that received vorasidenib in comparison with the placebo, those patients had a much improved prognosis, such that their progression-free survival was extended to 27.7 months compared with 11 months, which is a very large, statistically significant difference,” explained Katherine B. Peters, MD, PhD, neuro-oncologist at Duke Cancer Center, in an interview with Targeted Oncology^TM.

What the FDA’s Vorasidenib Approval Means for the Future of Glioma Therapy

In this follow-up article to the approval for vorasidenib, Timothy F. Cloughesy, MD, director of UCLA’s neuro-oncology program and distinguished professor in neurology, explains how this approval impacts the treatment landscape for glioma and provides an in-depth view of the phase 3 INDIGO trial (NCT04164901), which led to vorasidenib’s approval.

“This provides a real opportunity for all patients…to be able to hold off on radiation and chemotherapy for as long as possible allows these patients who are young, are either in the midst of their careers or are developing their careers or developing their families, to be able to be at their cognitive best during this time,” Cloughesy said. “And I think that is the huge value that we are seeing. We will understand more as data matures, just how long a period that could be.”

Thank you for joining us for this week’s Targeted Pulse. Look out for more recaps to come.

Here is last week’s Targeted Pulse in case you missed it.