September 30, 2023

The US Meals and Drug Administration (FDA) has accepted niraparib and abiraterone acetate (Akeega, Janssen Prescription drugs) to deal with BRCA-positive, metastatic castration-resistant prostate cancer in grownup sufferers with deleterious or suspected deleterious illness, as decided by an FDA-approved check.

The once-daily dual-action pill is the first-and-only orally administered remedy combining the PARP inhibitor niraparib with abiraterone acetate.

The FDA’s approval was based mostly on findings from the phase 3 MAGNITUDE precision medicine study, a randomized, placebo-controlled trial with 423 sufferers, 225 (53%) of whom had BRCA gene mutations as decided utilizing a tissue assay reminiscent of FoundationOne CDx.

Among the many subgroup with a BRCA mutation, radiographic progression-free survival was a median of 16.6 months vs 10.9 months (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.36 – 0.79; P = .0014). On this subgroup, an exploratory total survival evaluation demonstrated a median of 30.4 months vs 28.6 months (HR, 0.79; 95% CI, 0.55 – 1.12), favoring the remedy arm.

Though the general cohort (these with and with out BRCA mutations) demonstrated a big enchancment in radiographic progression-free survival, the subgroup with non-BRCA homologous recombination restore mutations didn’t show a big enchancment in radiographic progression-free survival, which signifies that the profit noticed was “primarily attributed” to the ends in the subgroup of sufferers with BRCA mutations, according to the FDA.

The protection profile of niraparib and abiraterone acetate plus prednisone was according to the identified security profile of every FDA-approved monotherapy. Critical antagonistic occasions occurred in 41% of sufferers within the remedy arm. These most frequently included musculoskeletal ache (44% vs 42%), fatigue (43% vs 30%), constipation (34% vs 20%), hypertension (33% vs 27%), and nausea (33% vs 21%).

An antagonistic response led to everlasting discontinuation of remedy in 15% of sufferers.

“As a doctor, figuring out sufferers with a worse prognosis is a precedence, particularly these whose cancers have a BRCA mutation,” principal investigator Kim Chi, MD, acknowledged within the Janssen press release. “We prospectively designed the MAGNITUDE examine to establish the subset of sufferers most certainly to learn from focused remedy with AKEEGA and to assist us perceive how we will probably obtain higher well being outcomes for sufferers.”

About 10% – 15% of sufferers who develop metastatic castration-resistant prostate most cancers have BRCA gene alterations, and people sufferers usually tend to have aggressive illness, poor outcomes, and shorter survival. Subsequently, this new agent “brings an vital remedy choice to sufferers with prostate most cancers as they think about their street forward,” said Shelby Moneer, vp of affected person packages and schooling at ZERO Prostate Most cancers.

The prescribing information lists the really helpful dose at 200 mg niraparib and 1000 mg abiraterone as soon as each day together with 10 mg of prednisone each day till illness development or unacceptable toxicity. Sufferers must also obtain a gonadotropin-releasing hormone analog concurrently or ought to have had bilateral orchiectomy.

Healthcare professionals ought to report all severe antagonistic occasions suspected to be related to the usage of any medication and system to the FDA’s MedWatch Reporting System or by calling 1-800-FDA-1088.

Sharon Worcester, MA, is an award-winning medical journalist based mostly in Birmingham, Alabama, writing for Medscape, MDedge, and different affiliate websites. She at present covers oncology, however she has additionally written on a wide range of different medical specialties and healthcare matters. She may be reached at  [email protected]  or on Twitter:  @SW_MedReporter .

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