Risk Management & Treatment

Biomarkers, targeted and immunotherapies for cancer

This section covers the following topics:

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 , , , ,  or other gene linked to a certain type of damage repair may benefit from a type of known as a
  • Men who test positive for an inherited mutation linked to , may benefit from the pembrolizumab (Keytruda). 

tests

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

tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. 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 Testing section for more information. 

Experts recommend  testing for cancer based on risk groups.

  • Men with low and favorable-intermediate-risk cancer and a life expectancy of > 10 years should consider multi-gene tumor testing. Multi-gene tumor testing can help predict how aggressive the cancer is and guide treatment.
    • multi-gene tumor tests include Decipher, Oncotype DX , Prolaris and ProMark.
  • Men with regional or metastic cancer should consider tumor testing for:
    • An abnormality known as ().
      • If tumor mutations in , , , or are found, patients should be considered for referral for genetic counseling and testing for an inherited mutation. 
    • An abnormality known as " (MSI-H or ) also known as "" ( or ).
      • cancers are common in people with a  gene mutations. People with advanced/metastatic   cancer may respond well to an  agent. 
  • Additional tests that may be used for metastic (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  most often used to treat advanced/metastatic 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 cancer that is MSI-H or and have had one line of therapy affecting the whole body.
  • Cancer treatment vaccines are a type of that uses a patient’s own cancer cells to boost their immune system.
    • Provenge (sipuleucel-T) may be used to treat patients with prostate cancer whose disease has progressed aftger hormonal treatment who have either no or very minimal symptoms related to the cancer.

Targeted therapies

The , Lynparza (olaparib) has received FDA-approval to treat men with , castration-resistent cancer, who have a mutation in , , or other gene linked to a certain type of damage repair. Lynparza may be used to treat men whose cancer has progressed on enzalutamide (Xtandi) or abiraterone (Zytiga).

The , Lynparza (olaparib) has received FDA-approval to treat men with , castration-resistent cancer, who have a mutation in , , or other gene linked to a certain type of damage repair. Lynparza may be used to treat men whose cancer has progressed on enzalutamide (Xtandi) or abiraterone (Zytiga).

Table of targeted and immunotherapies for  cancer

Name of drug Cancer Indication Type of agent
Lynparza
(olaparib)
castration-resistant cancer (mCRPC) Men with mCRPC whose cancer has progressed following treatment with Xtandi (enzalutamide) or  Zytiga (abiraterone) Inherited mutation in or or tumor mutation one of
the following genes: , , , , , CDK12, , FANCL, , RAD51B, ,  RAD54

()
castration-resistant 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 or
Provenge (sipuleucel-T) castration resistant cancer (mCRPC) For the treatment of asymptomatic or minimally symptomatic castrate resistant cancer No needed Cancer vaccine
Keytruda (pembrolizumab) or unresectable For treatment of that have progressed after treatment and for which there are no other treatment options MSI-H ( High) or  ( Immune checkpoint inhibitor
Keytruda (pembrolizumab) or unresectable

For the treatment of that have progressed following prior treatment and for which there are no satisfactory alternative treatment options

High (TMB-H) Immune checkpoint inhibitor
Vitrakvi (larotrectinib) solid tumors For treatment in solid tumors where surgical resection is likely to result in severe , and  for which there are no satisfactory alternative treatments or the cancer progressed following treatment NTRK fusion Kinase inhibitor

 

find-support find-support

The following organizations offer peer support services for people with, or at high risk for cancer:

updated: 01/30/2022

paying-for-service paying-for-service

Paying for testing

Insurance companies are required to cover the costs for cancer treatment. However, health plans may vary on the amount of out-of-pocket costs and coverage for specific doctors, facilities or treatments. Your doctor's office and treating hospital should disclose how much your treatment may cost you and work with your insurance company to help you plan for the cost of your care. Visit our Health Insurance Appeals page for additional information on insurance appeals. 

Medicare will cover the cost for genetic testing and testing for people who meet certain criteria. Medicare coverage varies based on the policies of Medicare in your region. Visit this site to find and contact your regional Medicare provider for more information about coverage. The Medicaid website has a link to state Medicaid programs, which list specific eligibility for each state.

Some laboratories have assistance programs that help cover the cost for tumor testing: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.

updated: 01/22/2022

paying-for-service paying-for-service

Paying for cancer treatment

The majority of public and private health insurance plans are required to cover cancer diagnosis and treatment; copays, coinsurance and deductibles often apply. Patient costs and coverage for specific doctors, facilities or treatments may vary based on your health plan. Visit our section on Insurance and Paying for Care: Treatment  for more information, links to sample appeal letters and other resources. 

Some pharmaceutical companies have assistance programs that help cover the cost for their medications: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Needy Meds: Assistance programs to help patients with cost of medications and other healthcare.
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.

updated: 01/22/2022

clinical-trials clinical-trials

The following are studies looking at PARP inhibitors and similar agents for treating people with advanced  cancer.  

A number of other clinical trials for people with  cancer can be found here.

updated: 04/16/2022

Last updated January 23, 2022