Cross-Resistance between Platinum-Based Chemotherapy and PARP Inhibitors in Castration-Resistant Prostate Cancer

SIMPLE SUMMARY: Platinum-based chemotherapy and PARP inhibitors are two types of treatment that can benefit prostate cancer patients with mutations in genes that are involved in the repair of damage in the DNA. However, patients who receive one type of treatment may not respond as well to the other treatment later on. The optimal sequencing of these agents is still unclear. In this study, we looked at how 28 prostate cancer patients responded to both treatments. We found that patients generally responded best to the initially given treatment, but still over 40% of patients responded to the second treatment. We also found that the efficacy of the second given treatment was higher in the order of platinum-based chemotherapy first and PARP inhibitor second, compared to the opposite order. ABSTRACT: Patients with metastatic castration-resistant prostate cancer (mCRPC) harbouring homologous recombination repair-related gene aberrations (HRRm) can derive meaningful benefits from both platinum-based chemotherapy (PlCh) and PARP inhibitors (PARPi). Cross-resistance between these agents is well-recognised in other tumour types but data on prostate cancer is lacking. In this retrospective pre-planned study, we assessed 28 HRRm mCRPC patients who received PlCh and PARPi. Progression-free survival (PFS) on initial therapy was longer than on subsequent therapy (median 5.3 vs. 3.4 months, p = 0.016). The median PFS of PlCh was influenced by the order of agents, with 3.6 months shorter PFS after PARPi than when administered first. The median PFS of PARPi was less influenced, with 0.9 months shorter PFS after PlCh than before. In the PARPi-first subgroup, six out of 16 evaluable patients (37.5%) had a >50% PSA decline to PlCh, and two of eight (25.0%) had a radiographic response to PlCh. In the PlCh-first subgroup, 6/10 (60.0%) had a >50% PSA decline, and 5/9 (55.6%) had a radiographic response to PARPi. These data show >40% of the cohort is sensitive to a subsequent HRR-targeting agent. PlCh appears to induce less cross-resistance than PARPi. Additional data on resistance mechanisms will be crucial in defining an optimal treatment sequence in HRRm mCRPC patients.