Prostate Cancer Awareness Month: Unmet Needs

In recognition of September as Prostate Cancer Awareness Month, Daniel Petrylak, MD, professor of oncology and urology at Yale School of Medicine, discusses the unmet needs in modern-day treatment of prostate cancer.

A primary challenge in modern oncology, especially in prostate cancer, is the proper sequencing of treatments. This wasn't as complicated 2 decades ago, Petrylak notes. For example, when docetaxel was approved, it was one of the few drugs that demonstrated a significant survival benefit, making the treatment path relatively straightforward. However, the landscape has changed dramatically. Today, clinicians have a multitude of approved agents for various stages of prostate cancer, often with overlapping indications.

This abundance of options creates a complex puzzle: What's the right treatment to give at the right time? The available agents include immunotherapeutic agents like sipuleucel-T (Provenge), and pembrolizumab (Keytruda) for select patients with microsatellite instability (MSI). There are also PARP inhibitors, various chemotherapeutic agents, and radioligand therapies such as lutetium Lu 177 vipivotide tetraxetan (Pluvicto), which targets prostate-specific membrane antigen (PSMA).

The decision of which treatment to administer first is critical because giving one treatment can sometimes preclude a patient from receiving other effective therapies later on. This makes the sequencing of these powerful drugs a major unmet need in the field. This issue isn't unique to prostate cancer. Other cancers, such as breast and lung cancer, have also benefited from the development of targeted therapies. In lung cancer, for example, clinicians can target specific genetic mutations like ALK and EGFR. Similarly, breast cancer treatments often target the HER2/neu gene.

While prostate cancer has seen advancements, such as the use of PARP inhibitors and lutetium for patients with PSMA expression, there's a recognized need for more targeted therapies. The focus of current research includes identifying new targets beyond PSMA, such as androgen receptor (AR) mutations. The hope is that by identifying and targeting these new molecular markers, clinicians can develop more personalized and effective treatment strategies.

Read the full interview with Dr Petrylak here.