Prostate Cancer, Genitourinary Cancer, Immunotherapy CME ACCREDITED Watch Time: 34 mins

touchEXPERT OPINIONS Immune checkpoint inhibitors in prostate cancer: Current and future practice

Watch leading experts consider the current role of immune checkpoint inhibitors in prostate cancer and possible future directions.

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Prof. Karim Fizazi
Gustave Roussy, Villejuif, France
How are immune checkpoint inhibitors currently used in prostate cancer?

Prof. Karim Fizazi outlines the current treatment landscape for immune checkpoint inhibitors in prostate cancer, including key clinical trial data, safety considerations and guideline recommendations.

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Interview Questions

In this interview, Prof. Karim Fizazi answers the following questions:

  • What is the potential role for CTLA-4 inhibitors in prostate cancer?
  • What data support PD-1/PD-L1 inhibition in prostate cancer?
  • What are the key safety data for pembrolizumab in prostate cancer?
  • How do immune checkpoint inhibitors currently fit into guideline-recommended treatment for prostate cancer?
About Prof. Karim Fizazi

Prof. Karim Fizazi is a medical oncologist at Institut Gustave Roussy, Villejuif, France and a Full Professor in Oncology at the University of Paris Saclay in Villejuif, France. read more

Prof. Fizazi is the president of the French Groupe d’Etude des Tumeurs Genito-Urinaires (GETUG). He is associate editor of the European Journal of Cancer. Furthermore, he has authored numerous abstracts at international congresses and has published more than 400 peer-reviewed articles. To push forward clinical research on prostate cancer in Europe, Prof. Fizazi created the Prostate Cancer Consortium in Europe (PEACE) in 2013. He is currently leading three large PEACE academic phase III trials.

Prof. Karim Fizazi discloses: Advisory board/panel fees from Advanced Accelerator Applications, Amgen, Astellas, AstraZeneca, Bayer, Clovis, CureVac, Essa Pharma, Genentech, Janssen, Merck Sharp & Dohme Corp., Orion and Sanofi.

 
Dr Sandy Srinivas
Stanford University, Stanford, CA, USA
Identifying patients with prostate cancer for treatment with immune checkpoint inhibitors

Dr Sandy Srinivas outlines why it is important to identify patients with prostate cancer who will benefit from immune checkpoint inhibitors, the current methodologies for identifying these patients and the future of biomarker testing for better patient stratification.

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Interview Questions

In this interview, Dr Sandy Srinivas answers the following questions:

  • Why is it important to identify patients who will benefit from immune checkpoint inhibitors?
  • Which pathophysiological factors have affected the results of immunotherapy trials in prostate cancer?
  • How does biomarker testing for immune checkpoint inhibitors currently fit into guideline-recommended treatment for prostate cancer?
  • What is the future of biomarker testing in prostate cancer?
About Dr Sandy Srinivas

Dr Sandy Srinivas is Professor of Medicine (Oncology) at Stanford University, CA, USA, where she is the clinical research group leader for the urologic cancer programme and is a principal investigator on numerous trials in urologic oncology. read more

Dr Srinivas serves as a vice-chair on the National Comprehensive Cancer Center (NCCN) panel for prostate cancer and has co-authored numerous publications and book chapters.

Dr Sandy Srinivas discloses: Advisory board/panel fees from Bayer, Eisai, Exelexis, Janssen, Merck & Co and Novartis. Grants/research support from Bayer, Exelexis, Merck & Co, Novartis and Seagen.

 
Prof. Johann de Bono
The Institute of Cancer Research, London, UK
Emerging treatment approaches with immune checkpoint inhibitors in prostate cancer

Prof. Johann de Bono outlines the data for immune checkpoint inhibitors as part of combination therapy for patients with prostate cancer.

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Interview Questions

In this interview, Prof. Johann de Bono answers the following questions:

  • What is the rationale behind using immune checkpoint inhibitors in combination with other treatments for prostate cancer?
  • How are PARP inhibitors being assessed in combination with immune checkpoint inhibitors for prostate cancer?
  • What are some of the key data for immune checkpoint inhibitors in combination with tyrosine kinase inhibitors for prostate cancer?
  • How are immune checkpoint inhibitors with different targets being studied in combination for prostate cancer?
  • What other drug combinations with immune checkpoint inhibitors look promising in prostate cancer?
About Prof. Johann de Bono

Prof. Johann de Bono is Regius Professor of Cancer Research at The Institute of Cancer Research (ICR), an independent college of The University of London and The Royal Marsden Hospital. He is the Head of the Division of Clinical Studies at the ICR and Director of The Royal Marsden Drug Development Unit. He leads The London Movember Prostate Cancer Centre of Excellence and the Royal Marsden Prostate Cancer Targeted Therapies team. read more

Prof. de Bono is a world leader in prostate cancer research, having changed the treatment of prostate cancer multiple times through trials of abiraterone, cabazitaxel, enzalutamide and olaparib. He has led the clinical development of multiple PARP inhibitors. His group has also co-led studies mapping the genomic landscape of advanced prostate cancer. This work has changed international guidelines on germline testing in men with advanced prostate cancer and has resulted in the first molecular stratification for this most common of male cancers. He has also led the clinical development of many other novel agents.

Prof. Johann de Bono discloses: Advisory board/panel fees from Amgen, Astellas, AstraZeneca, Bayer, Bioxcel Therapeutics, Boehringer Ingelheim, Cellcentric, Daiichi, Eisai, EMD Serono, Genentech/Roche, Genmab, GlaxoSmithKline, Harpoon, ImCheck Therapeutics, Janssen, Menarini/Silicon Biosystems, Merck Sharp & Dohme Corp., Orion, Pfizer, Qiagen, Sanofi Aventis, Sierra Oncology, Taiho, Terumo and Vertex Pharmaceuticals. Grants/research support from Astellas, AstraZeneca, Bayer, Cellcentric, Daiichi Sankyo, EMD Serono, Genentech, Genmab, GlaxoSmithKline, Janssen, Menarini/Silicon Biosystems, Merck Sharp & Dohme Corp., Orion, Pfizer, Sanofi Aventis, Sierra Oncology, Taiho and Vertex. Other Janssen (non-financial patent).

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Overview & Learning Objectives
Overview

In this activity, the expert faculty outline the current role of immune checkpoint inhibitors in prostate cancer, including supporting clinical trial data and how to identify patients that may benefit from this treatment modality. The possible role of immune checkpoint inhibitors as part of combination therapy in the future is also summarized.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of oncologists and urologists involved in the management of patients with prostate cancer.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Karim Fizazi discloses: Advisory board/panel fees from Advanced Accelerator Applications, Amgen, Astellas, AstraZeneca, Bayer, Clovis, CureVac, Essa Pharma, Genentech, Janssen, Merck Sharp & Dohme Corp., Orion and Sanofi.

Dr Sandy Srinivas discloses: Advisory board/panel fees from Bayer, Eisai, Exelexis, Janssen, Merck & Co and Novartis. Grants/research support from Bayer, Exelexis, Merck & Co, Novartis and Seagen.

Prof. Johann de Bono discloses: Advisory board/panel fees from Amgen, Astellas, AstraZeneca, Bayer, Bioxcel Therapeutics, Boehringer Ingelheim, Cellcentric, Daiichi, Eisai, EMD Serono, Genentech/Roche, Genmab, GlaxoSmithKline, Harpoon, ImCheck Therapeutics, Janssen, Menarini/Silicon Biosystems, Merck Sharp & Dohme Corp., Orion, Pfizer, Qiagen, Sanofi Aventis, Sierra Oncology, Taiho, Terumo and Vertex Pharmaceuticals. Grants/research support from Astellas, AstraZeneca, Bayer, Cellcentric, Daiichi Sankyo, EMD Serono, Genentech, Genmab, GlaxoSmithKline, Janssen, Menarini/Silicon Biosystems, Merck Sharp & Dohme Corp., Orion, Pfizer, Sanofi Aventis, Sierra Oncology, Taiho and Vertex. Other Janssen (non-financial patent).

Content Reviewer

Alicia Canalejo, MSN, ARNP-C has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 13 January 2022. Date credits expire: 13 January 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Discuss the current use of immune checkpoint inhibitors for prostate cancer
  • Identify patients who might benefit from immune checkpoint inhibitors using biomarkers
  • Describe emerging treatment approaches, such as combination therapies
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Question 1/4
Your patient with mCRPC progressed on treatment with docetaxel, and after biomarker testing is found to have MSI-H disease. Considering universal approval and reimbursement, which of the following treatment options would you consider?

mCRPC, metastatic castration-resistant prostate cancer; MSI-H, microsatellite instability high.
Correct

The NCCN guidelines recommend the use of pembrolizumab in patients with MSI-H mCRPC.1 Both the EAU and ESMO guidelines state that pembrolizumab is a treatment option in patients with MSI-H disease.2,3

Abbreviations

EAU, European Association of Urology; ESMO, European Society for Medical Oncology; mCRPC, metastatic castration-resistant prostate cancer; MSI-H, microsatellite instability high; NCCN, National Comprehensive Cancer Network.

References

1. NCCN. 2021. Available at: www.nccn.org/professionals/physician_gls/pdf/prostate.pdf (accessed 5 November 2021).
2. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2021. ISBN 978-94-92671-13-4.
3. Parker C, et al. Ann Oncol. 2020;31:1119–34.

Question 2/4
Your 66-year-old patient has mCRPC. Biomarker testing reported dMMR disease, and you have initiated treatment with pembrolizumab. During treatment, which of the following is most appropriate?

dMMR, mismatch repair deficient; mCRPC, metastatic castration-resistant prostate cancer.
Correct

The KEYNOTE-199 trial reported that 11% of patients had diarrhoea following treatment with pembrolizumab. There were no reports of sepsis, haematuria or thrombocytopenia.1

Reference

1. Antonarakis ES, et al. J Clin Oncol. 2020;38:395–405.

Question 3/4
Approximately what percentage of patients with mCRPC have a CDK12 mutation?

CDK12, cyclin-dependent kinase 12; mCRPC, metastatic castration-resistant prostate cancer.
Correct

An integrative genomic analysis of mCRPC samples reported aberrations of CDK12 in 6.9% of patients with mCRPC.1

Abbreviations

CDK12, cyclin-dependent kinase 12; mCRPC, metastatic castration-resistant prostate cancer.

Reference

1. Wu YM, et al. Cell. 2018;173:1770–82.

Question 4/4
In a phase Ib study evaluating cabozantinib plus atezolizumab in enzalutamide- and/or abiraterone-pretreated patients with mCRPC, approximately what percentage of patients had a confirmed overall response rate?

mCRPC, metastatic castration-resistant prostate cancer.
Correct

Cohort 6 of the phase Ib COSMIC-021 study, evaluating cabozantinib plus atezolizumab in enzalutamide and/or abiraterone-pretreated patients, reported a confirmed overall response rate of 32%.1

Reference

1. Agarwal N, et al. J Clin Oncol. 2020;38(Suppl. 6):139.

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