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Coquan E, Penel N, Lequesne J, Leman R, Lavaud P, Neviere Z, Brachet PE, Meriaux E, Carnot A, Boutrois J, Castera M, Goardon N, Muller E, Leconte A, Thiery-Vuillemin A, Clarisse B, Joly F. Carboplatin in metastatic castration-resistant prostate cancer patients with molecular alterations of the DNA damage repair pathway: the PRO-CARBO phase II trial. Ther Adv Urol 2024; 16:17562872241229876. [PMID: 38425504 PMCID: PMC10903225 DOI: 10.1177/17562872241229876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction DNA damage repair genes are altered in 20-35% of metastatic castration-resistant prostate cancer (mCRPC). Poly-ADP (Adénosine Diphosphate)-ribose polymerase inhibitors (PARPi) showed significant activity for these selected tumors, especially with homologous recombination repair (HRR) deficiency. These alterations could also predict platinum sensitivity. Although carboplatin was inconclusive in unselected mCRPC, the literature suggests an anti-tumoral activity in mCRPC with HHR gene alterations. We aimed to assess the efficacy of carboplatin monotherapy in mCRPC patients with HRR deficiency. Methods This prospective multicenter single-arm two-stage phase II addressed mCRPC men with HRR somatic and/or germline alterations, pretreated with ⩾2 taxane chemotherapy regimens and one androgen receptor pathway inhibitor. Prior PARPi treatment was allowed. Enrolled patients received intravenous carboplatin (AUC5) every 21 days for 6-9 cycles. The primary endpoint was the best response rate according to adapted PCWG3 guidelines: radiological response (RECIST 1.1 criteria) and/or biological response [⩾50% prostate-specific antigen (PSA) decline]. Results A total of 15 out of 16 enrolled patients started carboplatin treatment. Genomic alterations were identified for BRCA2 (n = 5), CDK12 (n = 3), ATM (n = 3) CHEK2 (n = 2), CHEK1 (n = 1), and BRCA1 (n = 1) genes. Objective response (partial biological response + stable radiological response) was achieved in one patient (6.7%), carrying a BRCA2 mutation and not pre-treated with PARPi; stable disease was observed for five patients (33.5%). Among seven patients (46.7%) with previous PARPi treatment, four patients (57.1%) had a stable disease. The median progression-free and overall survivals were 1.9 [95% confidence interval (95% CI), 1.8-9.5] and 8.6 months (95% CI, 4.3-19.5), respectively. The most common severe (grade 3-4) treatment-related toxicities were thrombocytopenia (66.7%), anemia (66.7%), and nausea (60%). Overall, 8 (53.3%) patients experienced a severe hematological event. Conclusion The study was prematurely stopped as pre-planned considering the limited activity of carboplatin monotherapy in heavily pre-treated, HHR-deficient mCRPC patients. Larger experience is needed in mCRPC with BRCA alterations. Trial registration NCT03652493, EudraCT ID number 2017-004764-35.
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Affiliation(s)
- Elodie Coquan
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
- Université de Lille, CHU Lille, ULR 2694 – Metrics: Evaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Justine Lequesne
- Department of Clinical Research, Centre François Baclesse, 3 Avenue du Général Harris, F-14076 CAEN Cedex 05, France
| | - Raphaël Leman
- Genetic and Oncology Biology Department, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Univ, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Pernelle Lavaud
- Department of Oncology, Institut Gustave Roussy, Villejuif, France
| | - Zoé Neviere
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Pierre-Emmanuel Brachet
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | - Emeline Meriaux
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | - Aurélien Carnot
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Jérémy Boutrois
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | - Marie Castera
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | - Nicolas Goardon
- Genetic and Oncology Biology Department, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Univ, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Etienne Muller
- Genetic and Oncology Biology Department, Centre François Baclesse, Caen, France
| | - Alexandra Leconte
- Department of Clinical Research, Centre François Baclesse, Caen, France
| | | | | | - Florence Joly
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- Department of Clinical Research, Centre François Baclesse, Caen, France
- Normandie University, UNICAEN, INSERM U1086 “ANTICIPE” (Interdisciplinary Research Unit for Cancers Prevention and Treatment), Centre François Baclesse, Caen, France
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