Advances in the identification of patients who may respond well to particular types of immunotherapy


A newly published paper by an international group of investigators has given us some further insight in to the roles of immunotherapeutic agents in the treatment of at least a subset of men with advanced forms of prostate cancer.

Rodrugues et al. have reported very detailed data on the associations between immunological alterations and genetic mismatch repair defects in 124 men with prostate cancer under treatment at the Royal Marsden Hospital in the UK. The full text of this paper is available on line for those who wish to read the details.

It has to be said that this is a very complex subject, and only a relatively small subset of men with advanced prostate cancer are ever likely to respond well to the use of drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) — the anti-PD-1 monoclonal antibodies. The available data now suggest that some 8 to 10 percent of men with advanced prostate cancer may be good candidates for this type of therapy. However, an article yesterday in Forbes provides more of a layperson’s overview of the implications of this research.

We also need to point out that there are going to be questions about whether some of these patients may respond particularly well to combination therapy with a PARP inhibitor and an anti-PD-1 monoclonal antibody. We are not aware of any good data on this topic as yet.

The good news, on the other hand, is the continuing evolution of our knowledge about differing way to treat differing subsets of men with advanced forms of prostate cancer based on the increasing range of clinical options available and our ability to identify specific subsets of men who may be good candidates for specific types of treatment.

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