The first precision medicine for prostate cancer could be on its way

What’s the medicine called?

It’s called olaparib, otherwise known as Lynparza, and it’s been available for patients with breast and ovarian cancer for quite some time.

What type of treatment is olaparib?

Olaparib is a type of treatment known as a PARP inhibitor, which targets cancer cells' ability to repair damage to their DNA. Previous evidence, including research funded by Prostate Cancer UK, showed that men with defects in their DNA damage repair genes were likely to respond to PARP inhibitors like olaparib.

The PROfound trial shows olaparib can be effective in men whose cancer has a mutation in one of 15 genes involved in repairing damage to DNA, including the BRCA1, BRCA2 and ATM genes. 

This makes olaparib the first example of a precision medicine for prostate cancer, which uses a detailed understanding of the tumour's genomics to work out which men will benefit.

Why can olaparib be used in men with prostate cancer?

In 2019, results from the PROfound trial showed olaparib delayed the progression of metastatic prostate cancer in men whose cancer cells have faulty DNA repair genes by around four months, compared to standard treatments like enzalutamide and abiraterone. The results also showed olaparib could extend survival by over three months, on average.

Which men could benefit?

Olaparib could make a huge difference to men with metastatic prostate cancer whose cancer cells have mutations in genes like BRCA, by offering them an alternative treatment option to cabazitaxel chemotherapy after their cancer has become resistant to hormone therapy. This means they’ll have stopped responding to androgen deprivation therapy (ADT) and either abiraterone or enzalutamide will have stopped working for them (depending on which they receive).

When will it be available?

Olaparib has been licensed by the MHRA for use in men with hormone-refractory metastatic prostate cancer who have a BRCA1 or BRCA2 mutation in their tumour cells, otherwise known as somatic mutations.

It’s now due to be appraised for use on the NHS in England, Wales and Northern Ireland by NICE in February this year. It will also need to be appraised for use in Scotland by the Scottish Medicines Consortium, which will happen later in 2021.

We can’t know when it will be approved for use, but we do know that in each of the UK’s four nations, plans are underway to enable men with advanced prostate to have the genomic tests needed to establish whether they have a BRCA1 or BRCA2 mutation in their tumour cells.