Dillon Cockrell, GU Medical Oncologist at Duke Cancer Institute, shared a post on LinkedIn:
“Several prostate cancer studies presented on Days 2 and 3 at ASCO26 may influence practice, while also raising important questions about patient selection and treatment intensity.
PROTEUS
- Plenary presentation: Perioperative apalutamide + ADT (6 months surgery 6 months) improved MFS (HR 0.80) and EFS (HR 0.71) in high-risk localized prostate cancer undergoing prostatectomy.
- Clinical impact is challenging. The control arm received perioperative ADT alone which is not SOC, making it difficult to compare these results with our current decision for definitive RT with ~2 years ADT or upfront surgery with salvage RT/ADT if needed.
- Not yet practice changing for me until we see the planned substudy comparison against surgery alone, but may be a paradigm shift in the future.
TALAPRO3
- In mHSPC with HRR alterations, talazoparib + ADT/enzalutamide improved rPFS (HR 0.48). OS trending but immature. Presented by Neeraj Agarwal.
- Better than expected subtype results (IMO) for non-BRCA (ATM, CDK12) suggesting PARP does have activity across a variety of HRR mutations.
- These data reinforce the importance of genomic testing and support PARP inhibitor use for appropriately selected patients, recognizing added long-term toxicity (anemia, MDS/AML risk).
ADREAM
- An Alliance for Clinical Trials in Oncology study evaluating an important patient-centered question about de-escalation and QOL with exceptional mHSPC responders to ADT/ARPI (PSA <0.2) stopping treatment at 18 months.
- 67% recovered testosterone and 41% remained off therapy with testosterone recovery at 18 months. Long-term outcomes to be followed.
- Meaningful data to bring to clinic tomorrow for patient counseling when considering treatment holidays and long-term QOL.
CHAMP
- For aggressive variant and neuroendocrine mCRPC, cabazitaxel/carboplatin plus ipilimumab/nivolumab achieved a 6-month PFS of 74% versus a historical benchmark of 55% with some long-term durable responses. Presented by our own Andrew Armstrong at Duke Cancer Institute.
- An intensive regimen for an aggressive disease, but the long-term survival signal was encouraging in a population with historically poor outcomes. ChemoIO should be considered and larger, funded trials are warranted.
ARACOG
- Randomized data showed less cognitive decline with ADT/darolutamide (-16%) than ADT/enzalutamide (-36%) at 24 weeks on MCCD test. Presented by Alicia Morgans.
- Findings support what many oncologists observe in practice and may be particularly relevant for frail or cognitively vulnerable patients.
Particularly proud of the contributions from our Duke Cancer Institute GU team who represented with multiple podium presentations and countless posters making continued progress for patients!”
