Talazoparib/Enzalutamide Improves Long-Term QOL in Metastatic CRPC

With longer-term follow-up, combining talazoparib (Talzenna) with enzalutamide (Xtandi) improved quality of life (QOL) compared with placebo plus enzalutamide in those with metastatic castration-resistant prostate cancer (CRPC), according to Arun Azad, PhD, MBBS, FRACP.

In a conversation with CancerNetwork^® at the 2024 Genitourinary Cancers Symposium, Azad, a medical oncologist, associate professor, and translational researcher at Peter MacCallum Cancer Centre with a primary focus on prostate cancer, spoke about subgroup analysis findings from the phase 3 TALAPRO-2 trial (NCT03395197) among patients with metastatic CRPC who were previously treated with novel hormonal therapy (NHT). Additionally, he discussed his strategies for managing toxicities, such as anemia, in patients treated with the talazoparib combination to help improve patient-reported outcomes, which included conducting laboratory assessments every 2 weeks and implementing dose reductions whenever necessary.

In the subgroup analysis of the TALAPRO-2 trial, investigators reported significant improvements with respect to physical functioning, role functioning, pain, and constipation among patients who received talazoparib plus enzalutamide compared with those who received placebo plus enzalutamide. However, investigators concluded that these findings should be interpreted with caution based on the small sample sizes and exploratory nature of their analysis.

Transcript:

With this combination, the talazoparib-related anemia—low red blood cell counts—is one of the major [adverse] effects. Of course, that can affect patient-reported outcomes because patients may be symptomatic with anemia, fatigue, shortness of breath, or whatever it might be. In this study with talazoparib, we monitored patients very closely in the first 3 to 4 months when the anemia is most likely to happen. They had labs done every 2 weeks to help us identify whether they developed anemia early so that we could then give an interrupted dose of the drug as needed, give a blood transfusion, and, if needed, do a dose reduction of the drug when it was restarted. That was an effective approach because the quality-of-life data in that period was similar even with the addition of talazoparib. Then with longer follow up, we saw that it was better, indicating better disease control. We're able to manage one of those key toxicities well without compromising patient-reported outcomes and quality of life.

Reference

De Giorgi U, Azad A, Fizazi K, et al. Patient-reported outcomes (PROs) with talazoparib (TALA) plus enzalutamide (ENZA) vs. placebo (PBO) plus ENZA in men with metastatic castration-resistant prostate cancer (mCRPC): Subgroup analysis of patients with novel hormonal therapy (NHT) pretreatment in the TALAPRO-2 study. J Clin Oncol. 2024;42(suppl 4):116. doi:10.1200/JCO.2024.42.4_suppl.116