Maha Hussain, MD, FACP, FASCO, discussesclinical trials evaluating therapeutics for patients with metastatic castrate-resistant prostate cancer.

Dr Hussain on Key Ongoing Clinical Trials in Metastatic Castrate-Resistant Prostate Cancer

Maha Hussain, MD, FACP, FASCO, Genevieve E. Teuton Professor of Medicine, Division of Hematology-Oncology, Department of Medicine, and deputy director and leader of the GU Oncology Program, Robert H. Lurie Comprehensive Cancer Center of the Northwestern University Feinberg School of Medicine, discusses clinical trials evaluating therapeutics for patients with metastatic castrate-resistant prostate cancer (mCRPC).

Clinicians still need a better understanding of why mCRPC progresses, because that will inform which pathways therapies should be developed for, Hussain begins. There are several ongoing clinical trials of interest, some of which are overlapping, Hussain continues. Studies are underway examining strategies such as PARP inhibition, AR inhibition, and radioligand therapy, Hussain explains.

Notable ongoing studies in mCRPC include the phase 2 BRCAAway trial (NCT03012321) and the phase 3 CONTACT-2 trial (NCT04446117). In the randomized BRCAAway study, investigators are comparing abiraterone acetate (Zytiga)/prednisone with olaparib (Lynparza) and with abiraterone/prednisone plus olaparib in patients with mCRPC with 

mutations, deletions, or loss of heterozygosity. Findings presented at the 2024 Genitourinary Cancers Symposium (ASCO GU) demonstrated that abiraterone/prednisone plus olaparib was well tolerated and resulted in an extended progression-free survival (PFS) compared with either agent alone or sequential therapy.

In CONTACT-2, investigators are evaluating cabozantinib (Cabometyx) plus atezolizumab (Tecentriq) vs second novel hormonal therapy in patients with mCRPC following progression on first novel hormonal therapy. Findings from CONTACT-2, which were also presented at ASCO GU, demonstrated that the combination significantly improved PFS vs second novel hormonal therapy in patients with mCRPC with extrapelvic nodal or visceral disease.

Studies of combination therapies are also of interest, Hussain notes. Additionally, there is a lot of work being done to move effective treatments into the hormone-sensitive space, Hussain says. This is often where there is the best chance to combat the cancer cells because the tumor has not developed resistance yet, Hussain explains. The hope is that data in the mCRPC space develop quickly, and new therapies and combinations will emerge in the near future, Hussain concludes.

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Maha Hussain, MD, FACP, FASCO, discusses clinical trials evaluating therapeutics for patients with metastatic castrate-resistant prostate cancer.

Maha H. Hussain, MD, FACP, Genevieve Teuton Professor of Medicine, deputy director, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 2015 Giant of Cancer Care

 in Genitourinary Cancers, discusses the potential of enzalutamide (Xtandi) in the treatment of patients with prostate cancer.

In July 2018, the FDA approved enzalutamide for the treatment of patients with non—metastatic castration-resistant prostate cancer, based on health-related quality of life data from the PROSPER trial. An important step in moving this agent forward, Hussain says, will be the release of the survival data from this study. Data presented at the 2018 ASCO Annual Meeting indicated that enzalutamide significantly improved the primary endpoint of metastases-free survival, compared with placebo. Without metastases, Hussain says, the risk of dying from prostate cancer simply is not there.

The future steps for enzalutamide are two-fold, Hussain adds. One would be to move the agent to an earlier phase of treatment, and the second would be to see how it can impact patients who don’t have metastases, but still have castrate-level testosterone.

Maha H. Hussain, MD, FACP, Genevieve Teuton Professor of Medicine, deputy director, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, discusses the potential of enzalutamide in prostate cancer.

Maha H. Hussain, MD, FACP

Articles

Dr Hussain on Key Ongoing Clinical Trials in Metastatic Castrate-Resistant Prostate Cancer

Dr. Hussain on Potential of Enzalutamide in Prostate Cancer