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Amol Akhade: ASCO 2025 Guideline Update: mCRPC Treatment Sequencing Simplified
May 6, 2025, 05:37

Amol Akhade: ASCO 2025 Guideline Update: mCRPC Treatment Sequencing Simplified

Amol Akhade, Senior Consultant Medical Oncologist and Hemato-Oncologist at Suyog Cancer Clinics and Reliance Hospitals, shared a post on LinkedIn:

ASCO 2025 Guideline Update: mCRPC Treatment Sequencing Simplified

A big step forward in how we treat metastatic castration-resistant prostate cancer (mCRPC)!
The latest ASCO update offers a structured, biomarker-driven, and personalized approach. Here’s what you need to know:

Start with Prior Exposure:
Treatment is now sequenced based on what the patient already received:

  1. ADT only
  2. ADT + ARPI
  3. ADT + Docetaxel
  4. Triplet (ADT + ARPI + Docetaxel)

Key Recommendations by Line:

  • BRCA1/2+: Start with PARPi + ARPI (e.g., talazoparib + enzalutamide)
  • Post-ARPI: Olaparib (BRCA+), Docetaxel/Cabazitaxel (HRR–)
  • Post-Docetaxel: Consider ARPI, Cabazitaxel, or Radium-223
  •  Triplet failure: 177Lu-PSMA-617 (PSMA+), PARPi or platinum combos

Biomarkers matter:

  • HRR mutation → PARPi
  • MSI-H/dMMR → Pembrolizumab
  • PSMA+ → Radioligand therapy
  • TP53/RB1/PTEN loss → Consider platinum chemo

Also emphasized:

  •  Early genetic testing
  • Equity in access
  • Shared decision-making
  • Supportive and palliative care from the start

Let’s move from reactive to proactive, and from empirical to personalized.”

Title: Systemic Therapy in Patients With Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update

Journal: Journal of Clinical Oncology

Authors: Rohan Garje, Irbaz Bin Riaz, Syed Arsalan Ahmed Naqvi, R. Bryan Rumble, Mary-Ellen Taplin, Terry M. Kungel, Daniel Herchenhorn, Tian Zhang, Kathryn E. Beckermann, Neha Vapiwala, Michael A. Carducci, Paul Celano, Sebastien J. Hotte, Arnab Basu, Hala Borno, Alan H. Bryce, Peng Wang, Elizabeth Wulff-Burchfield, Lisa Bodei, Andrew Loblaw, Robert J. Hamilton, Hamid Emamekhoo, Thomas A. Hope, Huan He, M. Hassan Murad, Hongfang Liu, James Elbert Williams, Rahul A. Parikh

Read the Full Article.

Amol Akhade

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