Przemyslaw W. Twardowski, MD, director, Prostate Oncology Strategic Program, director, Genitourinary Program, clinical professor, Department of Medical Oncology and Therapeutics Research, discusses the necessary steps to take toward determining optimal sequencing of treatments for patients with metastatic castration-resistant prostate cancer.

There is no good answer yet for this question in prostate cancer, Twardowski explains. In other tumor types, there is an advantage because there are specific biomarkers that guide therapy, as they can predict response to select agents. However, this is not confirmed yet in prostate cancer.

However, one that is showing promise is the specific variance of the androgen receptor (AR), which may predict responsiveness to various types of agents. Perhaps other subgroups or mutations in AR can also guide treatment decisions in the future, he adds.

There are also some specific genomic alterations that are being found in prostate cancer that have indications for drug development, one of which are DNA repair genes. The mutations in those genes can possibly predict the responsiveness to PARP inhibitors.

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Przemyslaw W. Twardowski, MD, director, Prostate Oncology Strategic Program, director, Genitourinary Program, clinical professor, Department of Medical Oncology and Therapeutics Research, discusses the necessary steps toward determining optimal sequencing of treatments for patients with metastatic castration-resistant prostate cancer.

Dr. Twardowski on Steps Toward Optimal Sequencing for mCRPC Therapies

Przemyslaw W. Twardowski, MD, director, Prostate Oncology Strategic Program, director, Genitourinary Program, clinical professor, Department of Medical Oncology and Therapeutics Research, medical oncologist, discusses the challenges with sequencing therapies for patients with metastatic castration-resistant prostate cancer (mCRPC).

These questions remain unanswered in the field of prostate cancer, explains Twardowski. There is an advantage in other tumor types, he adds, because there are biomarker-guided therapies. 

Experts in prostate cancer do not have much experience in making sequencing decisions, he says. Such choices are often based on clinical criteria and experience. In practice, Twardowski says he uses immunotherapy first as it tends to lay the foundation for future treatments. Additionally, physicians may also start with less toxic therapies and use more toxic options later on.

Przemyslaw W. Twardowski, MD, director, Prostate Oncology Strategic Program, director, Genitourinary Program, clinical professor, Department of Medical Oncology and Therapeutics Research, medical oncologist, discusses the challenge with sequencing therapies for patients with metastatic castration-resistant prostate cancer (mCRPC).

Przemyslaw W. Twardowski, MD

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