Praful Okay. Ravi, MB, BChir, MRCP, medical oncologist, Lank Middle for Genitourinary Oncology, Dana-Farber Most cancers Institute, teacher, medication, Harvard Medical College, discusses the prognostic worth and potential use of residual most cancers burden (RCB) to information intensified neoadjuvant therapy methods for sufferers with high-risk localized prostate most cancers.
Information from sufferers handled in 5 neoadjuvant trials at Dana-Farber Most cancers Institute between 2006 and 2018 have been pooled to guage the efficacy of 6 months of neoadjuvant androgen receptor pathway inhibitor (ARPI) remedy, particularly abiraterone acetate (Zytiga), enzalutamide (Xtandi), and abiraterone plus apalutamide (Erleada), mixed with androgen deprivation remedy (ADT).
Outcomes offered on the 2024 Kidney Most cancers Analysis Summit demonstrated that the 5-year metastasis-free survival price for sufferers with high-risk localized prostate most cancers who acquired this neoadjuvant remedy earlier than radical prostatectomy was over 80%. Furthermore, the depth of pathologic response was strongly prognostic for metastasis-free survival, with a 100% 5-year metastasis-free survival price in sufferers who achieved a pathologic full response.
Ravi discusses the implications of those information, noting that neoadjuvant remedy will not be but a normal of care. Nonetheless, the continuing part 3 PROTEUS trial (NCT03767244) goals to find out if therapy with apalutamide plus ADT earlier than and after radical prostatectomy in sufferers with localized high-risk or regionally superior prostate most cancers improves pathologic full response. If outcomes from PROTEUS show constructive, RCB might develop into a essential consider guiding post-neoadjuvant remedy methods, Ravi states.
Ravi envisions a situation the place sufferers obtain 6 months of neoadjuvant remedy with hormone remedy, ADT, and an ARPI. Sufferers who obtain a wonderful pathological response might be noticed post-surgery, he explains. Conversely, sufferers with vital residual illness (categorized as RCB2 or RCB3) might be candidates for trials exploring intensified post-neoadjuvant adjuvant methods, corresponding to chemotherapy or different brokers, he says. Nonetheless, Ravi notes the necessity to validate RCB as a prognostic device inside bigger cohorts, together with the PROTEUS examine and different trials, to make sure its robustness throughout completely different affected person populations.
If future research verify the advantages of neoadjuvant remedy and validate the usage of RCB, these findings may considerably affect scientific observe, Ravi emphasizes. The flexibility to stratify sufferers primarily based on their pathological response to neoadjuvant remedy would enable for extra personalised and doubtlessly simpler therapy methods, he concludes.
