mCRPC in focus
Transcript: Has management of mCRPC improved over time?
Professor Karim Fizazi
All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
Well the treatment of men with metastatic prostate cancer has dramatically evolved in the last two decades, and mostly in the last decade, to be honest.
First, mCRPC men benefited from the new treatments and Docetaxel first in the 2000 and then the second generation androgen receptor pathway inhibitors, abiraterone, enzalutamide and most recently apalutamide and darolutamide. And probably the most important evolution we've seen in the last five years or so was a move of these drugs to earlier stages where we see even more benefit for patients. And I'm speaking of years of additional survival benefit. And this is true, for example, for abiraterone, enzalutamide, darolutamide and apalutamide when they moved to the metastatic castration sensitive disease space. But even earlier in the course of a disease we have evidence that abiraterone clearly improves overall survival in men with localised disease, not even speaking about non-metastatic castration resistant disease.
Which means that the current treatment for men with metastatic castration resistant disease is also evolving simply because the drugs we were using in the last decade for these particular men are actually being used earlier. So we need to use different drugs when the patient reaches a stage. Fortunately enough we've seen newcomers including a second taxane, for example, cabazitaxel but also new families of agents such as PSMA targeted agents, lutetium PSMA, also PARP inhibitors at least in selected men with BRCA alteration. And this, you know, makes me move to genetic testing or molecular testing.
More and more I think we recognise that prostate cancer is just not one disease but numerous different diseases. And we need to tease this out on an individual basis to better treat all our patients. We are indeed currently testing all our patients and genetically somatic, but also germline to, for example to figure out whether they have BRCA alterations to decide for PARP inhibitor. And this is also true for MSI high which predicts for immunotherapy benefit just to provide a few examples.
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