NICE recommends new first-line treatment option for advanced prostate cancer

Prostate Cancer Research (PCR) welcomes the news that NICE has recommended a new medicine for men with untreated hormone-relapsed metastatic prostate cancer, also known as metastatic castration-resistant prostate cancer (mCRPC).

The treatment, talazoparib (Talzenna®), will provide an important new first-line treatment option for people whose prostate cancer has spread beyond the prostate and no longer responds to hormone therapy alone, and for whom chemotherapy is not considered suitable.

When prostate cancer becomes metastatic, it means the cancer has travelled to other areas of the body such as lymph nodes or bones. At this stage, treatment aims to keep the cancer under control for as long as possible, delay symptoms, and protect quality of life.

Despite recent progress, there remains a high unmet need for effective first-line treatments that can control disease, maintain quality of life and delay the need for chemotherapy. This is particularly important given that many people are either unable to tolerate chemotherapy or wish to postpone it for as long as possible.

Talazoparib is a PARP inhibitor, a targeted therapy that interferes with cancer cells’ ability to repair DNA damage. In combination with enzalutamide, an androgen receptor pathway inhibitor (ARPi), it offers a novel approach to treating advanced prostate cancer earlier in the disease pathway.

Similar to Olaparib, talazoparib can also be effective in targeting cancer with certain genetic variations, such as the BRCA1 or BRCA2 variants.

Current first-line options for hormone-relapsed metastatic prostate cancer include ARPi monotherapies such as abiraterone or enzalutamide, olaparib in combination with abiraterone and prednisolone, or watchful waiting in selected cases. However, no single treatment is suitable for everyone, and this provides an important additional option for patients.

Importantly, this new combination recommended by NICE provides a steroid-free option. This is particularly relevant for men who cannot tolerate steroids or who experience significant side effects from them.

It is important that this treatment is now delivered equitably, as data from the most recent National Prostate Cancer Audit has highlighted that less than half of men with metastatic prostate cancer are receiving the most recent treatments approved by NICE, with significant variations depending on where they live.