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ASCO GU 2023: Rucaparib Versus Docetaxel or Second-Generation Androgen Pathway Inhibition in Metastatic Prostate Cancer

By: Julia Fiederlein Cipriano
Posted: Monday, February 20, 2023

In a prior analysis of the multicenter phase III TRITON3 trial, rucaparib seemed to significantly prolong the duration of radiographic progression–free survival versus the physician’s choice of therapy in patients with chemotherapy-naive metastatic castration-resistant prostate cancer who harbored BRCA or ATM alterations. Alan Haruo Bryce, MD, of the Mayo Clinic, Phoenix, and colleagues reported the safety and efficacy of this PARP inhibitor compared individually with docetaxel and second-generation androgen pathway inhibitors, as well as the interim overall survival data, during the 2023 American Society for Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium (Abstract 18).

“Rucaparib significantly improved radiographic progression-free survival; safety was consistent with prior reports,” the investigators commented. “Interim overall survival results suggest a trend toward improvement for rucaparib.”

Patients harboring BRCA (n = 302) or ATM (n = 103) alterations whose disease progressed after one prior line of second-generation androgen pathway inhibition were randomly assigned in a 2:1 ratio to receive rucaparib or the physician’s choice of either docetaxel or a second-generation androgen pathway inhibitor (abiraterone or enzalutamide). At data cutoff, the overall survival maturity was 54% in the BRCA-mutated subgroup and 59% in the intention-to-treat population.

Treatment with rucaparib, the physician’s choice of therapy, docetaxel, and abiraterone and enzalutamide demonstrated median durations of radiographic progression-free survival of 11.2, 6.4, 8.3, and 4.5 months in the BRCA-mutated subgroup and 10.2, 6.4, 8.3, and 4.5 months in the intention-to-treat population, respectively; the median durations of overall survival were 24.3, 20.8, 18.9, and 22.1 months in the BRCA-mutated subgroup and 23.6, 20.9, 19.1, and 22.1 months in the intention-to-treat population. Asthenia/fatigue was the most frequently reported treatment-emergent adverse event with rucaparib (61.1%), docetaxel (67.6%), and abiraterone and enzalutamide (57.6%). The most common treatment-emergent adverse events of grade 3 or higher in each of these treatment arms were anemia (23.7%), neutropenia (14.1%), and hypertension (10.2%), respectively.

Disclosure: For full disclosures of the study authors, visit

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