Differential responses to taxanes and PARP inhibitors (PARPi) in ATM- versus BRCA2-mutated metastatic castrate-resistant prostate cancer (mCRPC) patients (pts).

Authors

Christopher Su

Christopher T Su

University of Michigan Rogel Cancer Center, Ann Arbor, MI

Christopher T Su , Emily Nizialek , Jacob E Berchuck , Panagiotis J. Vlachostergios , Ryan Ashkar , Alexandra Sokolova , Pedro C. Barata , Rahul Raj Aggarwal , Heather McClure , Nellie Nafissi , Alan Haruo Bryce , A. Oliver Sartor , Heather H. Cheng , Nabil Adra , Cora N. Sternberg , Mary-Ellen Taplin , Marcin Cieslik , Emmanuel S. Antonarakis , Ajjai Shivaram Alva

Organizations

University of Michigan Rogel Cancer Center, Ann Arbor, MI, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, Weill Cornell Medicine, New York, NY, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, University of Washington, Seattle, WA, Tulane Cancer Center, New Orleans, LA, University of California, San Francisco, San Francisco, CA, Mayo Clinic Arizona, Phoenix, AZ, Mayo Clinic, Phoenix, AZ

Research Funding

U.S. National Institutes of Health
U.S. National Institutes of Health

Background: PARPi have shown promise in mCRPC pts with mutations in DNA repair, but ATM- and BRCA2-altered pts may respond differently to PARPi. We hypothesized that differences may also exist for taxane therapy, aiding in treatment sequencing decisions. Methods: mCRPC pts (N = 137) with deleterious ATM or BRCA2 mutations who received taxanes, PARPi, or both were identified from 8 US academic centers. Demographic, treatment, and survival data were collected. Kaplan-Meier analyses were performed for time-to-treatment-discontinuation (TTD), as well as overall survival (OS), from time of first taxane or PARPi therapy. Cox hazard ratio (HR) regression analyses were performed, adjusting for Gleason sum (≤7 vs. 8-10). For OS, receipt of subsequent therapies following first taxane or PARPi was also included as a covariate. Results: 50 ATM- and 87 BRCA2-mutated pts were identified. 40/50 (80%) of ATM-mutated pts received taxane only or taxane prior to PARPi, while 10/50 (20%) received PARPi only or PARPi prior to taxane. ATM-mutated pts showed a trend towards longer TTD when taxane was given first vs PARPi given first (P = 0.08, adjusted HR for taxane treatment 0.50 [95% CI: 0.24–1.08]). Considering all pts who received taxane first, ATM-mutated pts had longer TTD than BRCA2-mutated pts who received taxane first (P= 0.04, adjusted HR for ATM 0.61 [CI: 0.37–0.99]). Among ATM-mutated pts, OS was longer in those receiving taxane first (P= 0.06, adjusted HR for taxane treatment 0.33 [CI: 0.10–1.05]). Among BRCA2-mutated pts, 43/87 (49%) received taxane first and 44/87 (51%) received PARPi first. BRCA2-mutated pts had longer TTD when PARPi was given first vs taxane given first (P< 0.0001, adjusted HR for PARPi treatment 0.32 [CI: 0.19–0.56]). Considering all pts who received PARPi first, BRCA2-mutated pts also had longer TTD than ATM-mutated pts who received PARPi first (P= 0.0031, adjusted HR for BRCA2 0.29 [CI: 0.12–0.66]). There was no significant OS difference in BRCA2-mutated pts regarding which treatment was given first (P= 0.63, adjusted HR for PARPi treatment 1.18 [CI: 0.59–2.35]). Conclusions: Our data in ATM- and BRCA2-mutated mCRPC pts suggests a trend towards improved clinical outcomes when taxanes are used prior to PARPi in ATM-mutated pts, while the reverse sequence appears to be better for BRCA2-mutated pts.


Taxane given first
PARPi given first
Adjusted Cox p
Median duration of therapy in ATM-mutated pts (95% CI)126 days (105-165)

N = 40
87 days (17-222)

N = 9
0.08
Median overall survival in ATM-mutated pts from time of first taxane or PARPi therapy509 days (319-987)

N = 25
279 days (18-not reached)

N = 5
0.06
Median duration of therapy in BRCA2-mutated pts122 days (84-136)

N = 43
224 days (111-335)

N = 33
< 0.0001
Median overall survival in BRCA2-mutated pts from time of first taxane or PARPi therapy545 days (394-828)

N = 32
453 days (343-632)

N = 15
0.63

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Genitourinary Cancer—Prostate, Testicular, and Penile

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Prostate Cancer– Advanced/Castrate-Resistant

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 5040)

DOI

10.1200/JCO.2021.39.15_suppl.5040

Abstract #

5040

Poster Bd #

Online Only

Abstract Disclosures