Genomic Testing Cannot be ‘Ignored’ in Metastatic Prostate Cancer

Germline and tumor somatic testing for mutations is “extremely important” for selecting suitable treatment options for those with metastatic prostate cancer, as well as monitoring and counseling patients on their survival, according to Neeraj Agarwal, MD.

In an interview with CancerNetwork®, Agarwal, a professor of medicine, presidential endowed chair of cancer research, and director of both the Genitourinary Oncology (GU) Program and the Center of Investigational Therapeutics at the Huntsman Cancer Institute (HCI) of the University of Utah, recommended that all patients with metastatic prostate cancer undergo genomic testing to match them with appropriate therapy based on their mutations. For example, he stated that patients with homologous recombination repair (HRR) pathway mutations may be suitable to receive treatment with PARP inhibitors administered as monotherapy or in combination with androgen receptor (AR) pathway inhibitors.

Transcript:

All patients with metastatic prostate cancer should undergo 2 types of testing as far as genomic testing is concerned. Number one is germline testing, where patients undergo testing to [assess whether] they have one of the mutations present in their germline DNA. [This] means they have inherited this mutation from their parents and may share these mutations with their siblings and their children. If they have germline mutations in HRR pathways, they are a candidate for treatment with PARP inhibitors.

The second type of testing is tumor genomic testing or somatic testing. There are multiple reasons why we should be doing the tumor testing for those genomic mutations. This tumor testing can be solid tumor testing, meaning you obtain the biopsy or the tumor tissue and order comprehensive genomic profiling, or you can even do with circulating tumor DNA. The reason we need to do that is because we have PARP inhibitors either as monotherapy or in combination with AR pathway inhibitors approved for patients who have HRR mutations.

Tumor genomic testing and germline testing do not just have implications only on family members and how we select therapies for these patients. These testing results also have other implications on how we monitor these patients, how often we should do scans, and how we counsel these patients about their survival. These tests, germline and tumor somatic testing, are extremely important and can no longer be ignored in the clinic when we see these patients.