4.6 Review

Progression in immunotherapy for advanced prostate cancer

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Novel Redirected T-Cell Immunotherapies for Advanced Prostate Cancer

Tanya B. Dorff et al.

Summary: Immunotherapy has not achieved long-lasting remissions in advanced prostate cancer patients. More potent T-cell redirecting strategies are needed to overcome the immunologically exclusive and suppressive tumor microenvironment. This review provides an in-depth perspective on the various immunotherapy strategies currently under clinical investigation for men with advanced prostate cancer.

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177Lu-PSMA-617 versus docetaxel in chemotherapy-naive metastatic castration-resistant prostate cancer: a randomized, controlled, phase 2 non-inferiority trial

Swayamjeet Satapathy et al.

Summary: Lu-177-PSMA-617 has been shown to be safe and non-inferior to docetaxel in the treatment of mCRPC, suggesting it could be potentially used earlier in the disease course rather than solely reserved for advanced end-stage disease.

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GD2-CART cell therapy for H3K27M-mutated diffuse midline gliomas

Robbie G. Majzner et al.

Summary: Diffuse intrinsic pontine glioma (DIPG) and other H3K27M-mutated diffuse midline gliomas (DMGs) are lethal pediatric tumors of the central nervous system. GD2-directed chimeric antigen receptor (CAR) T cells show promising preclinical efficacy. Four patients with H3K27M-mutated DIPG or spinal cord DMG were treated with GD2-CAR T cells and showed clinical and radiographic improvement.

NATURE (2022)

Article Biochemistry & Molecular Biology

Atezolizumab with enzalutamide versus enzalutamide alone in metastatic castration-resistant prostate cancer: a randomized phase 3 trial

Thomas Powles et al.

Summary: Early clinical data suggest that some patients with castration-resistant prostate cancer may benefit from PD-L1 inhibition, especially with enzalutamide. However, a trial combining atezolizumab with enzalutamide did not improve overall survival in unselected patients. Genomic and immune biomarkers associated with response to immune checkpoint inhibitors were identified.

NATURE MEDICINE (2022)

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Nicholas J. Vogelzang et al.

Summary: In patients with metastatic castration-resistant prostate cancer, the combination of DCVAC/PCa and chemotherapy as maintenance treatment did not extend overall survival and was well tolerated.

JAMA ONCOLOGY (2022)

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Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, Part II: Principles of Active Surveillance, Principles of Surgery, and Follow-Up

James A. Eastham et al.

Summary: This article aims to provide clinicians with treatment guidelines for patients with clinically localized prostate cancer. Detailed statements on active surveillance, surgical management, and patient follow-up are provided. Continued research and publication of high-quality evidence are crucial for further improving care for these patients.

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Clinically Localized Prostate Cancer: AUA/ASTRO Guideline. Part III: Principles of Radiation and Future Directions

James A. Eastham et al.

Summary: This article summarizes the principles of radiation and future directions of study in patients with clinically localized prostate cancer. The guidelines aim to aid clinicians in the management of these patients.

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Abiraterone plus prednisone added to androgen deprivation therapy and docetaxel in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2 x 2 factorial design

Karim Fizazi et al.

Summary: Combining androgen deprivation therapy, docetaxel, and abiraterone in de novo metastatic castration-sensitive prostate cancer improved overall survival and radiographic progression-free survival with a modest increase in toxicity, mostly hypertension.

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Androgen receptor activity in T cells limits checkpoint blockade efficacy

Xiangnan Guan et al.

Summary: Immune checkpoint blockade has revolutionized oncology by inducing durable anti-tumour immunity. In advanced prostate cancer patients, immunotherapy treatments have largely failed. However, inhibiting androgen receptor activity can increase the sensitivity of tumor-bearing hosts to checkpoint blockade therapy by enhancing CD8 T cell function and improving responsiveness to PD-1 targeted therapy.

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CAR T cells reach clinical milestone in prostate cancer

Nicholas P. Tschernia et al.

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PSMA-targeting TGFβ-insensitive armored CAR T cells in metastatic castration-resistant prostate cancer: a phase 1 trial

Vivek Narayan et al.

Summary: CAR T cells show promising efficacy in hematologic malignancies, but face challenges in solid tumors due to the immunosuppressive tumor microenvironment. This study reports results from a phase 1 trial using engineered CAR T cells resistant to TGF-beta signaling in castration-resistant prostate cancer patients, showing both efficacy and dose-dependent toxicity. Future studies should explore multipronged approaches to improve outcomes in this setting.

NATURE MEDICINE (2022)

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Phase 2 trial of T-cell activation using MVI-816 and pembrolizumab in patients with metastatic, castration-resistant prostate cancer (mCRPC)

Douglas G. McNeel et al.

Summary: The combination of programmed cell death 1 blockade and MVI-816 is safe and can enhance tumor-specific T cells, resulting in a favorable 6-month disease control rate. The occurrence of immune-related adverse events is significantly associated with prolonged time on treatment.

JOURNAL FOR IMMUNOTHERAPY OF CANCER (2022)

Article Medicine, General & Internal

Comparative Effectiveness of Immune Checkpoint Inhibitors vs Chemotherapy by Tumor Mutational Burden in Metastatic Castration-Resistant Prostate Cancer

Ryon P. Graf et al.

Summary: This study compared the treatment outcomes of immune checkpoint inhibitors (ICI) and taxane chemotherapy in mCRPC patients based on tumor mutational burden (TMB). The results showed that ICI was more effective than taxanes in patients with high TMB, but not in those with low TMB.

JAMA NETWORK OPEN (2022)

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Docetaxel enhances the therapeutic efficacy of PSMA-specific CAR-T cells against prostate cancer models by suppressing MDSCs

Xiaokang Zhang et al.

Summary: This study investigates the combinative application of docetaxel and PSMA-CAR-T cells for the treatment of prostate cancer. The results demonstrate that this combination therapy can effectively inhibit the growth of prostate cancer cells in vitro and in vivo, potentially mitigating the adverse effects of chemotherapy.

JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY (2022)

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Yishen Wang et al.

Summary: This review discusses the current evidence for the use of prostate-specific membrane antigen (PSMA) PET and whole-body (WB) MRI in prostate cancer diagnosis and treatment. PSMA PET and WB MRI have been shown to have higher accuracy in detecting metastatic lesions and have potential in monitoring treatment response. However, more clinical trials are needed to determine their specific roles in patient management.

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Nivolumab plus rucaparib for metastatic castration-resistant prostate cancer: results from the phase 2 CheckMate 9KD trial

Karim Fizazi et al.

Summary: The study showed that nivolumab plus rucaparib is effective in patients with HRD-positive postchemotherapy or chemotherapy-naive mCRPC, especially those with BACA1/2 mutations. Safety profile was as expected with no new signals identified. It remains unclear whether the addition of nivolumab provides incremental improvements over rucaparib alone.

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Cabozantinib combination therapy for the treatment of solid tumors: a systematic review

Daniel Castellano et al.

Summary: This study conducted a systematic review to evaluate the clinical efficacy and safety of cabozantinib combination therapy for solid tumors. The results from randomized studies suggest that cabozantinib combined with other therapies may lead to improved progression-free survival in certain tumor types compared to current standards of care.

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Cancer Statistics, 2021

Rebecca L. Siegel et al.

Summary: Every year, the American Cancer Society projects the numbers of new cancer cases and deaths in the United States, with the latest data showing a significant decline in lung cancer mortality, while prostate cancer mortality has plateaued and breast and colorectal cancer mortality have slowed. Improvements in treatment have accelerated progress against lung cancer, leading to a record drop in overall cancer mortality.

CA-A CANCER JOURNAL FOR CLINICIANS (2021)

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AMG 757, a Half-Life Extended, DLL3-Targeted Bispecific T-Cell Engager, Shows High Potency and Sensitivity in Preclinical Models of Small-Cell Lung Cancer

Michael J. Giffin et al.

Summary: AMG 757, a bispecific T-cell engager targeting DLL3, demonstrated potent antitumor activity in SCLC models, activating T cells and inducing significant tumor regression. It showed good tolerability in nonhuman primates and has the potential for intermittent administration in patients, suggesting it as a promising option for targeting DLL3-expressing SCLC tumors in clinical settings.

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Randomized Phase II Trial of Sipuleucel-T with or without Radium-223 in Men with Bone-metastatic Castration-resistant Prostate Cancer

Catherine H. Marshall et al.

Summary: The study aimed to investigate whether radium-223 enhances peripheral immune responses to sipuleucel-T in men with bone-predominant, minimally symptomatic metastatic castration-resistant prostate cancer. Results showed that patients receiving the combination treatment of sipuleucel-T and radium-223 were more likely to experience a PSA decline, as well as longer progression-free survival and overall survival.

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May Daher et al.

Summary: CAR engineering has transformed the field of cellular therapy for cancer treatment by redirecting the specificity of immune effector cells. The use of natural killer (NK) cells as platforms for CAR engineering has emerged as a safe and effective alternative to traditional CAR-T cells. Expanding this strategy beyond T lymphocytes may lead to safer and more effective off-the-shelf cellular therapy products to combat cancer.

CANCER DISCOVERY (2021)

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Exosome-based liquid biopsies in cancer: opportunities and challenges

W. Yu et al.

Summary: Liquid biopsy in cancer research has seen significant progress, with efforts focused on utilizing circulating tumor cells, circulating tumor DNA, and extracellular vesicles like exosomes. Exosomes, as part of the intercellular communication system, carry tumor-derived materials and can serve as stable biomarkers for early detection and monitoring of cancer.

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Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Hyuna Sung et al.

Summary: The global cancer burden in 2020 saw an estimated 19.3 million new cancer cases and almost 10.0 million cancer deaths. Female breast cancer surpassed lung cancer as the most commonly diagnosed cancer, while lung cancer remained the leading cause of cancer death. These trends are expected to rise in 2040, with transitioning countries experiencing a larger increase compared to transitioned countries due to demographic changes and risk factors associated with globalization and a growing economy. Efforts to improve cancer prevention measures and provision of cancer care in transitioning countries will be crucial for global cancer control.

CA-A CANCER JOURNAL FOR CLINICIANS (2021)

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The PSMA-targeting Half-life Extended BiTE Therapy AMG 160 has Potent Antitumor Activity in Preclinical Models of Metastatic Castration-resistant Prostate Cancer

Petra Deegen et al.

Summary: AMG 160, a bispecific T-cell engager immuno-oncology therapy targeting PSMA in mCRPC, demonstrates potent antitumor activity in vitro and in vivo. It shows enhanced cytotoxic activity when combined with diagnostic or therapeutic agents such as the PSMA-imaging agent, novel hormonal therapy, and immune checkpoint blockade. Preclinical data supports ongoing clinical evaluation in patients with mCRPC.

CLINICAL CANCER RESEARCH (2021)

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BiTE-ing into Prostate Cancer with Bispecific T-cell Engagers

Nikhil V. Kamat et al.

Summary: Targeting PSMA with AMG 160 shows promising preclinical efficacy in inducing T cell-driven cytolytic activity against prostate cancer, highlighting its potential therapeutic implications in immune oncology.

CLINICAL CANCER RESEARCH (2021)

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Safety and Clinical Activity of Atezolizumab in Patients with Metastatic Castration-Resistant Prostate Cancer: A Phase I Study

Daniel P. Petrylak et al.

Summary: Atezolizumab monotherapy showed good tolerability and evidence of disease control in patients with metastatic castration-resistant prostate cancer (mCRPC), albeit with limited efficacy. Further studies are needed to evaluate the potential benefits of combination therapy in this population.

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EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

Nicolas Mottet et al.

Summary: The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on screening, diagnosis, and treatment of localized prostate cancer summarize the most recent recommendations for clinical practice, including risk-adapted strategies, medical imaging utilization, biopsy techniques, patient classification, and treatment options. Recommendations include consideration of moderate hypofractionation for intermediate-risk patients and a combination of local treatment with long-term hormonal therapy for cN1 PCa patients.

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Pasotuxizumab, a BiTE® immune therapy for castration-resistant prostate cancer: Phase I, dose-escalation study findings

Horst-Dieter Hummel et al.

Summary: The study reported the results of a first-in-human study of pasotuxizumab in patients with advanced castration-resistant prostate cancer. The data showed significant PSA response in some patients, suggesting the potential efficacy of this therapy in treating solid tumors.

IMMUNOTHERAPY (2021)

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Prostate Cancer, Version 1.2021 Featured Updates to the NCCN Guidelines

Edward Schaeffer et al.

Summary: The NCCN Guidelines for Prostate Cancer provide recommendations for staging and risk assessment post-diagnosis, with management options for localized, regional, and metastatic disease. The guidelines also cover disease monitoring and treatment of recurrent disease. The NCCN Prostate Cancer Panel meets annually to update recommendations based on new clinical data, aiming to provide the most effective care for patients.

JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK (2021)

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[177Lu]Lu-PSMA-617 versus cabazitaxel in patients with metastatic castration-resistant prostate cancer (TheraP): a randomised, open-label, phase 2 trial

Michael S. Hofman et al.

Summary: [Lu-177]Lu-PSMA-617 showed a higher PSA response and fewer grade 3-4 adverse events compared to cabazitaxel in men with metastatic castration-resistant prostate cancer.

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FDA approves fourth CAR-T cell therapy

Asher Mullard

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Elise A. Chong et al.

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Clinical and immunologic impact of short-course enzalutamide alone and with immunotherapy in non-metastatic castration sensitive prostate cancer

Ravi A. Madan et al.

Summary: This study evaluated the potential synergy of immunotherapy and enzalutamide in non-metastatic castration sensitive prostate cancer (nmCSPC), as well as the immunologic impact of enzalutamide on men with normal testosterone levels. Results showed that three months of enzalutamide without androgen deprivation therapy (ADT) induced significant PSA control and had an impact on immune profiles.

JOURNAL FOR IMMUNOTHERAPY OF CANCER (2021)

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Bispecific Antibodies in Prostate Cancer Therapy: Current Status and Perspectives

Jonas S. Heitmann et al.

Summary: Despite recent advances in cancer therapy with immunotherapy, there is still a lack of breakthrough for metastasized prostate carcinoma (PC) and T cell-based immunotherapeutic strategies have not been successfully established for PC treatment. Current focus is on the clinical development of bispecific antibodies (bsAbs) in the treatment of PC, with potential advantages over CAR-T cells, but challenges persist in achieving success in solid tumors.

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High tumor mutation burden fails to predict immune checkpoint blockade response across all cancer types

D. J. McGrail et al.

Summary: Analysis of over 10,000 patient tumors from The Cancer Genome Atlas showed that TMB-H tumors had significantly higher response rates to immune checkpoint blockade in certain cancer types, while showing no significant benefit in others. These results do not support the use of TMB-H as a biomarker for ICB treatment across all solid cancer types, indicating the need for further tumor type-specific studies.

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Cross-resistance and drug sequence in prostate cancer

Stefan A. J. Buck et al.

Summary: The expanding landscape of advanced prostate cancer treatment has seen the move of ARSIs and taxane chemotherapy to earlier stages, leading to the emergence of cross-resistance as a major challenge in current clinical practice. Understanding the mechanisms of cross-resistance is crucial in order to overcome this obstacle and improve treatment outcomes.

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Intratumoural administration and tumour tissue targeting of cancer immunotherapies

Ignacio Melero et al.

Summary: Immunotherapies such as immune-checkpoint inhibitors and CAR T cells are transforming oncology and hematology, but systemic distribution poses safety concerns. Intratumoural delivery and tumour tissue-targeted compounds show promise in enhancing the efficacy of immunotherapies, with potential to induce abscopal or anenestic effects in preclinical models. Clinical trials evaluating these strategies face challenges related to administration methodology, pharmacokinetics, and response assessments.

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Industrializing engineered autologous T cells as medicines for solid tumours

Cedrik M. Britten et al.

Summary: Cell therapy is a rapidly growing field in the pharmaceutical industry with significant therapeutic potential, particularly in the treatment of blood cancers. Despite success in this area, challenges remain in treating solid tumors. To fully industrialize engineered T cell therapies as mainstream medicines, they need to provide unique clinical effects and be applicable in currently unaddressed disease contexts.

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Andrew J. Hou et al.

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Pre-existing immune status associated with response to combination of sipuleucel-T and ipilimumab in patients with metastatic castration-resistant prostate cancer

Meenal Sinha et al.

Summary: Combining CTLA-4 blockade with sipuleucel-T resulted in modest clinical activity. The timing of CTLA-4 blockade following sipuleucel-T did not alter antigen-specific responses. Clinical responses were associated with both lower baseline frequencies of CTLA-4 expressing T cells and a history of radiation therapy.

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Next Generation Sequencing Technology in the Clinic and Its Challenges

Lau K. Vestergaard et al.

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A Phase lb Study of Atezolizumab with Radium-223 Dichloride in Men with Metastatic Castration-Resistant Prostate Cancer

Lawrence Fong et al.

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KEYNOTE-921: Phase III study of pembrolizumab plus docetaxel for metastatic castration-resistant prostate cancer

Daniel P. Petrylak et al.

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Shahneen Sandhu et al.

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Philipp Wolf et al.

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