Edwin Posadas, MD
Researchers are tapping into new treatment strategies with a focus on quality of life for patients with prostate cancer; however, oncologists still only have a surface-level understanding of the biology of the disease, said Edwin M. Posadas, MD, FACP.
, Posadas discussed recent prostate cancer data and shed light on where emerging therapies may fit into this landscape.
OncLive: What were the biggest takeaways you had from the prostate cancer data that were presented at the 2019 Genitourinary Cancers Symposium?
: The prostate cancer session had a lot of great work in several important areas. One of the big ones [focused on] AR-targeted therapies. We saw updated data with drugs we already know, such as enzalutamide, but we got a nice look at some of the initial clinical data with darolutamide—this information has been anticipated by the field. We also had a nice little taste of what has been happening with PARP inhibitors [in this space]. There is, of course, the immunotherapy question that remains unanswered at this time.
Then, there is the idea of looking at different biological phenotypes. We heard a nice discussion about the use of the PAM50 classifier historically being brought into the breast cancer space. The relevance of that general theme is important in prostate cancer and it’s where we will select therapies for patients, including [AR-targeted] drugs as well as PARP inhibitors. We are in for a lot.
Where do you see darolutamide fitting into the treatment paradigm?
There are a couple of important things that came out of the ARAMIS trial. First, the bar was set pretty high. With enzalutamide and apalutamide already available and used by most clinicians at this point, darolutamide had to demonstrate that it was just as active [as those agents]. That bar was very clearly met, and I do not think anyone left the presentation hall thinking darolutamide was “a day late and a dollar short” in terms of activity.
Some data that were emphasized were interesting, and a lot of data were actually underemphasized. It was nice that we got to see the chemical structure of the drug, and it became very clear to us that this is a very different molecule—that is important. [It has been] emphasized that it has a lack of penetration into the central nervous system, which will hopefully drive down toxicity; the data seem to support that so far. As more data come in with these larger trials—TITAN is down the road—it will be interesting to see how the toxicity matters will play out, especially in a sicker patient population.
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