I've Tested Positive, Now What?
Risk Management & Treatment > Cancer Treatment > By Cancer Type > Prostate > Biomarkers, targeted and immunotherapies
Biomarkers, targeted and immunotherapies for cancer
This section covers the following topics:
- Genetic testing for inherited mutations for treatment selection
- Tumor testing for treatment selection
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 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.
- An abnormality known as ().
- 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 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.
The , Lynparza (olaparib) has received FDA-approval to treat mCRPC after the cancer has progressed on the drugs enzalutamide (Xtandi) or abiraterone (Zytiga) in people with a mutation in , , or other gene linked to a certain type of damage repair.
The , () has received FDA-approval to treat mCRPC, in people who have an inherited mutation in or (found through genetic testing) or a tumor mutation in or (found through tumor testing or ).
Table of targeted and immunotherapies for cancer
|Name of drug||Cancer||Indication||Type of agent|
|castration-resistant cancer (mCRPC)||For treatment of mCRPC which 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)||For treatment of mCRPC which has 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|
The following organizations offer peer support services for people with or at high risk for cancer:
- FORCE peer support
- Visit our message boards.
- Once you register, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Sign up for our Peer Navigation Program.
- Users are matched with a volunteer who shares their mutation and situation.
- Join our private Facebook group.
- Find a virtual or in-person support meeting.
- Join a Zoom community group meeting.
- Visit our message boards.
- ZERO-The End of Cancer is a nonprofit organization that provides information and support resources for men with cancer.
The following studies are looking at PARP inhibitors and similar agents for treating people with advanced cancer.
- NCT04592237: Chemotherapy, and for the Treatment of Aggressive Variant Cancer. This study will look at how well the combination of chemotherapy drugs (such as cabazitaxel and carboplatin), a PARP inhibitors (), and an agents (cetrelimab) works for treating people with a rare type of cancer known as aggressive variant cancer (AVPC).
- NCT04821622: TALAPRO-3: A Clinical Trial in Men with Castration-Sensitive Cancer (mCSPC) and Damage Repair (DDR) Gene Alterations. TALAPRO-3 is a trial for men who have been diagnosed with castration-sensitive cancer (mCSPC) which means that the tumor has spread to other parts of the body but it is still sensitive to hormone therapies.
- NCT05005728: XmAb®20717 Alone or in Combination With Chemotherapy or in Patients With Castration-Resistant Cancer. This study will look at the safety and clinical activity of the drug XmAb20717 alone or in combination with standard-of-care anticancer therapies in patients with castration-resistant cancer who have been treated with at least 2 prior lines of treatment.
- NCT04455750: A Clinical Study Evaluating The Benefit of Adding to Enzalutamide for Men With Prostate Cancer That Has Become Resistant To Testosterone-Deprivation Therapy. This trial is evaluating the benefit of and enzalutamide combination therapy versus enzalutamide alone for the treatment of men with prostate cancer that has become resistant to testosterone-deprivation therapy.
- NCT03317392: Studying the Medication Olaparib Given with Radium-223 for Advanced Cancer with Bone . This study is measuring the best dosage for and side effects of the drug combination olaparib and radium-223 to treat men with mCRPC that has spread to the bones.
- NCT04497844: Treatment for Castration-Sensitive Cancer and Inherited or Tumor Mutations in Damage Repair Genes (Amplitude). The goal of AMPLITUDE is to see if adding to standard of care hormone therapy (ADT) is safe and more effective than standard of care alone. The study is enrolling people who have castration-sensitive cancer and have an inherited or tumor mutation in one of the following genes involved in damage repair: , , , , FANCA,PALB2, RAD51B and RAD54L.
Other clinical trials for people with cancer can be found here.