The scientific programme of ASCO20 Virtual covered a wide spectrum of developments in prostate cancer management. Found below are the latest and most relevant data presented at the event.
Screening for prostate cancer (currently mainly PSA-based) may be overthrown by fast MRI [abstract 5513]. Overdiagnosis may be reduced while maintaining detection rates of significant cancer. Identification of the patients at the highest risk is increasingly important; further characterization of germline BRCA2 carriers was performed in PROREPAIR-A [abstract 5511]. Regarding primary treatment for prostate-only radiation, the optimal setting of concomitant ADT may be adjuvant versus neoadjuvant [abstract 5584].
PSMA-targeted imaging maintains its position due to high sensitivity compared to conventional imaging both in the primary, as well as, recurrent disease setting. However, it is not easily accessible in the United States as it is in Europe and Australia. Also, it is not yet fully known how the resulting shift in risk grouping should be interpreted for clinical management [abstracts 5501 and 5502]. The TheraP trial shows promising PSA response rates with theranostic Lutetium, but the impact on harder endpoints should be waited for [abstract 5500].
Many new agents or combinations of existing drugs are the subject of investigation. Oral GnRH receptor antagonist relugolix performance was not inferior to leuprolide for advanced hormone-sensitive prostate cancer with quicker testosterone recovery and potential fewer side effects for patients with a history of cardiovascular events [abstract 5602].
The first studies replacing standard ADT by novel ARTAs have also been presented (abiraterone + ADT vs apalutamide vs abiraterone + apalutamide) [abstract 5505]. Specific biomarkers may aid in selecting the most appropriate patients for pembrolizumab after docetaxel in the M+CRPC setting (abstract 5526). An ATR kinase inhibitor (labelled M6620) may be combined with carboplatin in 3rd line treatment of CRPC patients [abstract TPS252]. Finally, the Cyclone2 trial will cover the effect of combining abiraterone with CDK4/6 inhibitor abemaciclib [abstract TPS 5591].