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Targeted Therapy

Targeted therapy uses drugs that "target" a particular characteristic of the tumor. Learn more about if this treatment might be an option for you.

A Black man talking to his doctor at a desk

Targeted therapy for prostate cancer is a type of therapy that identifies, or “targets”, a particular genetic component of the tumor. The goal is to interfere with the specific molecules that drive the growth of the tumor.

A targeted therapy approach is a form of personalized cancer treatment, also referred to as precision medicine. It is often associated with fewer side effects than other treatments. Targeted therapies may be used by themselves or in combination with other therapies.

There are currently two main types of targeted therapies for metastatic prostate cancer patients: PARP inhibitors and PSMA-targeted therapies.

PARP Inhibitors

PARP Inhibitors

PARP inhibitors are a type of targeted therapy that affects how DNA is repaired in cancer cells. They target certain genetic mutations. Therefore, they're only used in patients who are known to have the targeted genetic mutation found through genetic testing.

Are PARP inhibitors right for you?

Are PARP Inhibitors Right for You?

The following PARP inhibitors have been approved by the FDA for treatment of metastatic castration resistant prostate cancer (mCRPC), for patients who have certain gene mutations.

Niraparib combined with abiraterone acetate (Akeega®) can be used to treat mCRPC patients with a known BRCA gene mutation.

Olaparib (Lynparza®) can be used to treat mCRPC patients with a known BRCA gene mutation in two ways:

     -In combination with the hormone therapy drug abiraterone (Zytiga®)

     -By itself, if the cancer has progressed after treatment with a hormone therapy drug such as enzalutamide (Xtandi®) or abiraterone

Rucaparib (Rubraca®) can be used to treat mCRPC that has grown after treatment with chemotherapy and hormone therapy, and in patients with a known BRCA gene mutation.

Talazoparib (Talzenna®) can be used to treat mCRPC patients that have homologous recombination repair (HRR) gene mutation(s)* and haven't received prior treatment for castration-resistant disease. Talazoparib can be given with enzalutamide once per day.

*Targeted HRR genes include: ATM, ATR, BRCA1, BRCA2, CDK12, CHEK2, FANCA, MLH1, MRE11A, NBN, PALB2, and RAD51C.

How do PARP inhibitors work?

How Do PARP Inhibitors Work?

There are two major ways to repair DNA damage in cells. If one fails, the other can make up the difference. PARP inhibitors interrupt (or prevent) one DNA repair system from working. Cells with mutations like BRCA1 and BRCA2 have a decreased ability to repair DNA damage in the second system. If both ways to repair the DNA in a tumor cell are stopped, DNA damage adds up and that causes the tumor cells to die.

What are the side effects?

What Are the Side Effects of PARP Inhibitors?

Side effects of PARP inhibitors include fatigue, nausea, vomiting, decreased appetite, rash, anemia, constipation, and diarrhea. Some patients experience more serious side effects that include bone marrow problems and blood clots.

Talk with your doctor to see if PARP inhibitors are a treatment option for you, and to discuss potential side effects and how to manage them.

Dr. Tomasz Beer in his doctor's jacket

PSMA therapeutics with Dr. Tomasz Beer

In this session from the 2022 ZERO Summit, Dr. Tomasz Beer discusses PSMA imaging and PSMA-targeted therapy for prostate cancer.

PSMA-targeted therapies

PSMA-targeted therapies

PSMA, or prostate-specific membrane antigen, is a protein found on the surface of normal prostate cells. It is found in higher amounts on prostate cancer cells. It is present in more than 80% of prostate cancer cells in men with prostate cancer.

PSMA has been the subject of extensive and promising research over the last several decades. It is now used as a target for imaging to diagnose metastatic or recurrent prostate cancer, and it is also being explored as a target for medications that can treat prostate cancer.

How is PSMA targeted for treatment?

How is PSMA Targeted for Treating Prostate Cancer?

Targeting PSMA enables treatment to focus on the prostate cancer cells rather than healthy cells in the body. This allows a precision medicine approach to treatment. PSMA treatments will likely be made available to patients who have high levels of PSMA protein detected on their cancer cells using a PSMA PET scan.

Lutetium Lu 177 vipivotide tetraxetan (Pluvicto®), also know as Lu-PSMA, is a PSMA-targeted radioligand therapy (RLT) approved by the FDA to treat mCRPC.

Lutetium Lu 177 is being further studied for use in earlier stages of prostate cancer and in combination with other treatments. Several other PSMA-targeted therapies are being explored for prostate cancer, including other radioligand therapies, antibody-drug conjugates, cellular immunotherapy, photodynamic therapy, imaging-guided surgery, and others.

What are the side effects?

What are the Side Effects of PSMA-Targeted Therapies?

Common side effects of Lutetium Lu 177 include fatigue, dry mouth, nausea, decreased appetite, constipation, and diarrhea. There are some potentially serious side effects, including bone marrow problems and kidney problems.

Talk with your doctor to see if PSMA-targeted therapy is a treatment option for you, and to discuss potential side effects and how to manage them.