Metastatic Castration-Resistant Prostate Cancer with BRCA2 Mutation: The Challenge Incorporating PARP Inhibitors and Platinum in Treatment Sequencing

Inês Nogueira Costa; Joana Reis; Sara Meireles; Maria João Ribeiro; Miguel Barbosa; Isabel Augusto

doi:10.12890/2022_003331

Metastatic Castration-Resistant Prostate Cancer with BRCA2 Mutation: The Challenge Incorporating PARP Inhibitors and Platinum in Treatment Sequencing

Eur J Case Rep Intern Med. 2022 May 24;9(5):003331. doi: 10.12890/2022_003331. eCollection 2022.

Authors

Inês Nogueira Costa¹, Joana Reis¹, Sara Meireles¹, Maria João Ribeiro¹, Miguel Barbosa¹, Isabel Augusto¹

Affiliation

¹ Medical Oncology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.

Abstract

Prostate cancer is the second most frequent malignancy in men worldwide. Despite the improvement in survival achieved by increasingly early diagnosis and advances in treatment, it is still associated with high mortality. Because of its molecular heterogeneity, there is a need to identify genetic alterations in order to apply targeted therapies. Increasing evidence suggests that the PARP inhibitor olaparib could have a significant synthetic lethal effect in prostate cancer with homologous recombination defects, such as BRCA1/2 mutations. It is not yet known if, under these circumstances, platinum-based chemotherapy induces higher response rates in prostate cancer. We present the case of a patient with BRCA2-mutated metastatic castration-resistant prostate cancer whose treatment sequence included carboplatin and olaparib.

Learning points: Metastatic castration-resistant prostate cancer (mCRPC) remains a lethal disease despite significant progress in treatment.The BRCA2 mutation is associated with worse survival and so timely genetic screening is important.Studies are needed to identify the best therapeutic sequencing strategy for mCRPC harbouring homologous recombination repair defects, which includes PARP inhibitors and platinum.

Keywords: BRCA2 germline mutation; BRCA2-mutated metastatic castration-resistant prostate cancer; Metastatic prostate cancer; PARP inhibitor; carboplatin; olaparib.