Prostate Cancer: Targeted and Immunotherapies

Targeted and Immunotherapies for Prostate Cancer

This section covers the following topics:

What is targeted therapy?

Targeted therapy is a type of cancer treatment designed to attack or kill cancer cells, while sparing normal cells as much as possible. These drugs are designed to target abnormal proteins, receptors or genes that are found in cancer cells or the surrounding tissue.  

PARP inhibitors 

PARP inhibitors are a type of targeted therapy that works by blocking a protein that the body uses to repair DNA damage. They were initially developed to treat cancers in people with an inherited BRCA1 or BRCA2 mutation. 

The following PARP inhibitors are used to treat metastatic castration-resistant prostate cancer (mCRPC). 

• The PARP inhibitor Talzenna (talazoparib) may be used in combination with Xtandi as a first-line treatment for mCRPC in people who have an inherited mutation found through genetic testing or tumor mutation found through tumor testing in BRCA1, BRCA2, ATM, ATR, CDK12, CHEK2, FANCA, MLH1, MRE11A, NBN, PALB2, or RAD51C.
• The PARP inhibitor, Lynparza (olaparib) may be used in combination with Zytiga and prednisone or prednisolone for the first-line or later treatment of mCRPC in patients with an inherited BRCA1 or BRCA2 mutation (found through genetic testing) or tumor BRCA1 or BRCA2 mutation (found through tumor testing or liquid biopsy). 
• The PARP inhibitor, Lynparza may be used to treat mCRPC after the cancer has progressed on the drugs Xtandi (enzalutamide) or Zytiga (abiraterone) in people with an inherited mutation in BRCA1, BRCA2 (found through genetic testing) or a tumor mutation in BRCA1, BRCA2, ATM, BARD1, BRIP1, CDK12, CHEK1, CHEK2, FANCL, PALB2, RAD51B, RAD51C, RAD51D, RAD54L (found through tumor testing).
• The PARP inhibitor, Rubraca (rucaparib) may be used to treat mCRPC, in people who have an inherited mutation in BRCA1 or BRCA2 (found through genetic testing) or a tumor mutation in BRCA1 or BRCA2 (found through tumor testing or liquid biopsy).
• Akeega is a new drug that combines the PARP inhibitor, Zejula (niraparib) with the hormone therapy, Zytiga. Akeega is used with prednisone to treat mCRPC in people who have an inherited mutation or a tumor mutation in BRCA1 or BRCA2 (found through tumor testing or liquid biopsy).

Other targeted therapies

• Pluvicto (lutetium Lu 177 vipivotide tetraxetan) is a type of targeted radiation used to treat mCRPC for men previously treated with with hormone therapy with an androgen receptor inhibitor and taxane-based chemotherapy. It targets a receptor called PSMA found on the surface of prostate cancer cells. 
• Enhertu (trastuzumab deruxtecan) is a type of targeted therapy approved for treatment many different types of advanced cancers (including prostate cancer) if tumor testing shows a biomarker called HER2-positive.

Researchers are studying new ways to use targeted therapies to treat prostate cancer, including:  Visit our Featured Research section for more information.

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 after hormonal treatment and who have minimal symptoms related to the prostate cancer.

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Table listing targeted and immunotherapies for prostate cancer