mCRPC in focus
Transcript: mCRPC: Treatment landscape
Professor Silke Gillessen
Interview recorded February 2025. All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
So yes, so I think that's a very good question. So the mCRPC landscape is changing really kind of like really fast, so there's a lot of dynamic. And mostly, maybe two reasons, because we are adding the active substances from mCRPC more and more in the hormone-sensitive space. So we did it with docetaxel, we did it with the ARPIs. Now we sometimes even give the triplets and we will have data, hopefully soon, for Lu-PSMA, for PARP inhibitors, for ACE inhibitors, for, I mean, a lot of the new substances that all, hopefully, will go also in the hormone-sensitive disease space.
So, in consequence, we have a bit less left in the mCRPC space, and the choice of what we are using for our patients in this first kind of mCRPC space, or also afterwards, is very much dictated by what they had in the hormone-sensitive space, and that makes it now a bit more complicated, but I guess also more like challenging to understand. Also, we spoke a lot about the granularity for patients with hormone-sensitive disease, but also understand better the subgroups of patients with first line mCRPC, because also here we find really very different patients.
We have patients who, unfortunately, have the triplet and progress very fast after finishing the chemotherapy. And we had an abstract here that these patients, whatever you give them as first line mCRPC really don't do well and we need new substances. And there was really a very interesting abstract in the rapid oral session about mevrometostat. I think you've talked about it before. But I think, you know, these are the interesting new drugs that are coming. So it looked, to me, quite impressive results. So here, I think, you know, this is the second thing that's coming. I think there's a lot of new mechanisms, lot of new modes of action, like T-cell engagers and so on, that really calming in that space. So yes, we are using more of the old, more old fashioned things in the hormone-sensitive space. But the good thing is that, on the horizon, there is so many new drugs coming and I think that's really very positive. But I think we have to be very careful that we select the patients well. As I said, there are the really aggressive variants where we need really urgently new drugs, new mechanisms.
But they are also patients who, under ADT and RP, have a very slowly progressing disease and maybe in these patients, we need other drugs. So I think, you know, there is a lot to do. It would be ideal if you could do molecular selection. We have that, in a way, with the PARPP inhibitors, or not in a way, this is, yeah, it's now a bit discussed with the OS data that you have already discussed from TALAPRO-2. And some patients who are MSI-high. But, of course, it would be nice if we would go in the direction of lung cancer where we really have a lot of molecularly selected therapies for our patients.
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