Objective:

The article examines the objective, findings, and clinical context described in FDA expands talazoparib use in prostate cancer.

Approach:

• Approval: The FDA approved talazoparib with enzalutamide for adults with HRR-mutated metastatic androgen pathway modulation-naïve or -sensitive prostate cancer. An FDA-authorized test is required to identify eligible mutations.
• Evidence: The decision was supported by TALAPRO-3, a randomized, double-blind, placebo-controlled phase 3 trial of 599 patients. Participants received talazoparib plus enzalutamide or placebo plus enzalutamide; all continued androgen deprivation therapy.
• Treatment: The recommended talazoparib dose is 0.5 mg orally once daily with enzalutamide, alongside a gonadotropin-releasing hormone analog or after bilateral orchiectomy.

Key Findings:

• Talazoparib plus enzalutamide reduced the risk of radiographic progression or death by 52% versus placebo plus enzalutamide (hazard ratio, 0.48).
• Median radiographic progression-free survival was not reached with the combination and was 45.8 months in the control group.
• Overall survival data were immature at the time of analysis.
• Grade 3 or higher anemia occurred in 51% of combination-treated patients and 3% of control patients; anemia led to permanent talazoparib discontinuation in 5%.

Interpretation:

The approval extends the combination's use to HRR-mutated metastatic prostate cancer before castration resistance develops.

Limitations:

• Overall survival data were immature at the time of analysis.

Conclusion:

Prescribing information warns of myelodysplastic syndrome or acute myeloid leukemia, myelosuppression, and embryo-fetal toxicity. Complete blood counts should be monitored before treatment and monthly thereafter. Dose reductions are recommended for moderate or severe renal impairment.

Sources:

• FDA
• Pfizer