Cancer Treatment > By Cancer Type > Prostate > Biomarkers, targeted and immunotherapies
Biomarkers, targeted and immunotherapies for prostate cancer
This section covers the following topics:
- Genetic testing for inherited mutations for treatment selection
- Tumor biomarker testing for treatment selection
- Immunotherapy
- Targeted therapy
Genetic tests for inherited mutations for treatment selection
Any person diagnosed with mCRPC meets national guidelines for genetic testing for an inherited mutation. Genetic testing may be used to guide treatment selection.
- Men with mCRPC who test positive for an inherited mutation in BRCA1, BRCA2, ATM, CHEK2, PALB2 or other gene linked to a certain type of DNA damage repair may benefit from a type of targeted therapy known as a PARP inhibitor.
- Men who test positive for an inherited mutation linked to Lynch syndrome, may benefit from the immunotherapy pembrolizumab (Keytruda).
Biomarker tests
Biomarker tests look at samples of blood, tumor or other tissue for changes or abnormalities caused by cancer. These tests can give doctors clues about the cancer, including:
- how fast the cancer is growing
- which treatments are most likely to work
- whether or not the cancer is responding to treatment or growing
- whether or not the cancer has come back after remission
Biomarkers for treatment selection
Biomarker tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. Biomarker tests used to select a specific treatment are sometimes called "companion diagnostic tests." These tests may be done on tumor tissue or (in many cases) on blood. See our Biomarker Testing section for more information.
Experts recommend biomarker testing for prostate cancer based on risk groups.
- Men with low and favorable-intermediate-risk prostate cancer and a life expectancy of > 10 years should consider multi-gene tumor testing. Multi-gene tumor testing can help predict how aggressive the prostate cancer is and guide treatment.
- Prostate multi-gene tumor tests include Decipher, Oncotype DX Prostate, Prolaris and ProMark.
- Men with regional or metastic prostate cancer should consider tumor testing for:
- An abnormality known as homologous recombination deficiency (HRD).
- If tumor mutations in BRCA1, BRCA2, PALB2, ATM or CHEK2 are found, patients should be considered for referral for genetic counseling and testing for an inherited mutation.
- An abnormality known as “microsatellite instability" (MSI-H or MSI-high) also known as "mismatch repair deficiency" (dMMR or MMR-D).
- MSI-high cancers are common in people with a Lynch syndrome gene mutations. People with advanced/metastatic MSI-high prostate cancer may respond well to an immunotherapy agent.
- An abnormality known as homologous recombination deficiency (HRD).
- Additional biomarker tests that may be used for metastic castration-resistant prostate cancer (mCRPC) include AR-V7 testing. AR-V7 stands for Androgen Receptor Variant 7. AR-V7 is a blood test that looks for a form of the androgen receptor that makes androgen therapy less effective. AR-V7 testing can help identify patients who would not benefit from androgen receptor therapies.
Immunotherapies
Immunotherapies are cancer treatments that help the body’s immune system detect and attack cancer cells.
- Immune checkpoint inhibitors are a type of immunotherapy most often used to treat advanced/metastatic prostate cancer that have MSI-H or dMMR; usually after other treatments have been tried.
- Keytruda (pembrolizumab) may be used to treat patients with castration resistant prostate cancer that is MSI-H or dMMR and have had one line of therapy affecting the whole body.
- Cancer treatment vaccines are a type of immunotherapy that uses a patient’s own cancer cells to boost their immune system.
- Provenge (sipuleucel-T) may be used to treat patients with metastatic prostate cancer whose disease has progressed aftger hormonal treatment who have either no or very minimal symptoms related to the prostate cancer.
Targeted therapies
The PARP inhibitor, Lynparza (olaparib) has received FDA-approval to treat men with metastatic, castration-resistent prostate cancer, who have a mutation in BRCA1, BRCA2, ATM or other gene linked to a certain type of DNA damage repair. Lynparza may be used to treat men whose prostate cancer has progressed on enzalutamide (Xtandi) or abiraterone (Zytiga).
The PARP inhibitor, Lynparza (olaparib) has received FDA-approval to treat men with metastatic, castration-resistent prostate cancer, who have a mutation in BRCA1, BRCA2, ATM or other gene linked to a certain type of DNA damage repair. Lynparza may be used to treat men whose prostate cancer has progressed on enzalutamide (Xtandi) or abiraterone (Zytiga).
Table of targeted and immunotherapies for prostate cancer
Name of drug | Cancer stage | Indication | Biomarker | Type of agent |
---|---|---|---|---|
Lynparza (olaparib) |
Metastatic castration-resistant prostate cancer (mCRPC) | Men with mCRPC whose cancer has progressed following treatment with Xtandi (enzalutamide) or Zytiga (abiraterone) | Inherited mutation in BRCA1 or BRCA2 or tumor mutation one of the following genes: ATM, BRCA1, BRCA2, BARD1, BRIP1, CDK12, CHEK2, FANCL, PALB2, RAD51B, RAD51C, RAD51D , RAD54 |
PARP inhibitor |
Rubraca (rucaparib) |
Metastatic castration-resistant prostate cancer (mCRPC) | Men with mCRPC who have been treated with androgen receptor-directed therapy and a taxane-based chemotherapy | Inherited or acquired (tumor) mutation in BRCA1 or BRCA2 | PARP inhibitor |
Provenge (sipuleucel-T) | Metastatic castration resistant prostate cancer (mCRPC) | For the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant prostate cancer | No biomarker needed | Cancer vaccine |
Keytruda (pembrolizumab) | Metastatic or unresectable solid tumors | For treatment of solid tumors that have progressed after treatment and for which there are no other treatment options | MSI-H (Microsatellite Instability High) or MMR-D (Mismatch Repair Deficiency) | Immune checkpoint inhibitor |
Keytruda (pembrolizumab) | Metastatic or unresectable solid tumors |
For the treatment of solid tumors that have progressed following prior treatment and for which there are no satisfactory alternative treatment options |
Tumor Mutational Burden High (TMB-H) | Immune checkpoint inhibitor |
Vitrakvi (larotrectinib) | Metastatic solid tumors | For treatment in metastatic solid tumors where surgical resection is likely to result in severe morbidity, and for which there are no satisfactory alternative treatments or the cancer progressed following treatment | NTRK fusion | Kinase inhibitor |
If you have prostate cancer, you can find peer support through the following resources:
- FORCE support:
- Register for the FORCE Message Boards to connect with others who share your situation. Once you register, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- FORCE's Peer Navigation Program will match you with a volunteer who shares your mutation and situation and provide you with a free resource guide.
- Contact your local FORCE impact leaders to be connected to resources in your community.
-
Attend an online support meeting.
- Other organizations that offer support:
- Us Too is an international nonprofit organization for men with prostate cancer and their loved ones.
- ZERO - The End to Prostate Cancer is a nonprofit organization that provides information and support resources for men with prostate cancer.
The following cancer treatment studies are open to people diagnosed with prostate cancer.
Advanced solid tumors (including breast, ovarian, pancreatic, prostate or others)
- NCT03565991: A Phase II Study to Evaluate the Safety and Anti-tumor Activity of Avelumab in Combination with Talazoparib in Patients with a BRCA or ATM Mutation. This study is looking at the safety and effectiveness of the combination of an immunotherapy (known as Avelumab) and a PARP inhibitor (known as Talazoparib) is for treating patients with locally advanced or metastatic solid tumors who have an inherited mutation in ATM, BRCA1 or BRCA2.
- NCT03718091: M6620 (VX-970) in Selected Solid Tumors. This is a phase 2 study looking at M6620, a drug designed to inhibit the ATR enzyme. Inhibiting ATR may block how cancers repair their damaged DNA. The study is specifically enrolling patients with an inherited mutation in BRCA1 or BRCA2 or tumor mutations in BRCA1, BRCA2 BARD1, BRIP1, CDK12, CHEK2, NBN, PALB2, RAD51B, RAD51C and other mutations.
- NCT04171700: A Study to Evaluate Rucaparib in Patients With Solid Tumors and With Deleterious Mutations in HRR Genes (LODESTAR). This study is evaluating the response of rucaparib in patients with various solid tumors and with deleterious mutations in Homologous Recombination Repair (HRR) genes, including BRCA1, BRCA2, PALB2, RAD51C, RAD51D, BARD1, BRIP1, FANCA, NBN, RAD51 or RAD51B.
Prostate cancer
- NCT04030559: Niraparib Before Surgery in Treating Patients With High Risk Localized Prostate Cancer and DNA Damage Response Defects. This trial studies how well niraparib, when given before surgery, works in treating patients with high risk prostate cancer that has not spread to other parts of the body. The study is open to men with an inherited or acquired mutation in a gene associated with DNA repair deficiency.
- NCT03012321: Abiraterone/Prednisone, Olaparib, or Abiraterone/Prednisone + Olaparib in Patients With Metastatic Castration-Resistant Prostate Cancer With DNA Repair Defects. This is a phase II study in men with metastatic castration resistant prostate cancer (mCRPC) open to men with an inherited or acquired mutation in a gene associated with DNA repair deficiency.
- NCT03338790: A Phase 2 Study of Nivolumab in Combination with Either Rucaparib, Docetaxel, or Enzalutamide in Men with Castration-resistant Metastatic Prostate Cancer (CheckMate-9KD). The purpose of this study is to compare three different combination therapies, each containing a drug called nivolumab and another anti-cancer drug in men metastatic prostate cancer.
- NCT02975934: A Study of Rucaparib Verses Physician's Choice of Therapy in Patients With Metastatic Castration-resistant Prostate Cancer and Homologous Recombination Gene Deficiency (TRITON3). TRITON3 study is looking at how well the PARP inhibitor rucaparib (Rubraca) works for men with a BRCA or other gene mutation and advanced prostate cancer.
- NCT03442556: Docetaxel, Carboplatin, and Rucaparib Camsylate in Treating Patients With Metastatic Castration Resistant Prostate Cancer With Homologous Recombination DNA Repair Deficiency. This trial studies how well docetaxel with carboplatin followed by rucaparib camsylate works in treating patients with metastatic castration resistant prostate cancer. The study is open to men with an inherited or acquired mutation in a gene associated with DNA repair deficiency.
Visit our Research Search and Enroll Tool to find additional cancer treatment studies.