Rucaparib for the Treatment of Metastatic Castration-resistant Prostate Cancer Associated with a DNA Damage Repair Gene Alteration: Final Results from the Phase 2 TRITON2 Study

Wassim Abida*, David Campbell, Akash Patnaik, Alan H Bryce, Jeremy Shapiro, Richard M Bambury, Jingsong Zhang, John M Burke, Daniel Castellano, Albert Font, Vinod Ganju, Anne-Claire Hardy-Bessard, Ray McDermott, Brieuc Sautois, Dominique Spaeth, Eric Voog, Josep M Piulats, Elias Pintus, Charles J Ryan, Axel S MerseburgerGedske Daugaard, Axel Heidenreich, Karim Fizazi, Andrea Loehr, Darrin Despain, Andrew D Simmons, Melanie Dowson, Jowell Go, Simon P Watkins, Simon Chowdhury

*Corresponding author for this work
24 Citations (Scopus)

Abstract

BACKGROUND: Initial TRITON2 (NCT02952534) results demonstrated the efficacy of rucaparib 600 mg BID in patients with metastatic castration-resistant prostate cancer (mCRPC) associated with a BRCA1 or BRCA2 (BRCA) or other DNA damage repair (DDR) gene alteration.

OBJECTIVE: To present the final data from TRITON2.

DESIGN, SETTING, AND PARTICIPANTS: TRITON2 enrolled patients with mCRPC who had progressed on one or two lines of next-generation androgen receptor-directed therapy and one taxane-based chemotherapy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was objective response rate (ORR; as per the modified Response Evaluation Criteria in Solid Tumor Version 1.1/Prostate Cancer Clinical Trials Working Group 3 criteria in patients with measurable disease by independent radiology review [IRR]); prostate-specific antigen (PSA) response rate (≥50% decrease from baseline [PSA50]) was a key secondary endpoint.

RESULTS AND LIMITATIONS: As of July 27, 2021 (study closure), TRITON2 had enrolled 277 patients, grouped by mutated gene: BRCA (n = 172), ATM (n = 59), CDK12 (n = 15), CHEK2 (n = 7), PALB2 (n = 11), or other DDR gene (Other; n = 13). ORR by IRR was 46% (37/81) in the BRCA subgroup (95% confidence interval [CI], 35-57%), 100% (4/4) in the PALB2 subgroup (95% CI, 40-100%), and 25% (3/12) in the Other subgroup (95% CI, 5.5-57%). No patients within the ATM, CDK12, or CHEK2 subgroups had an objective response by IRR. PSA50 response rates (95% CI) in the BRCA, PALB2, ATM, CDK12, CHEK2, and Other subgroups were 53% (46-61%), 55% (23-83%), 3.4% (0.4-12), 6.7% (0.2-32%), 14% (0.4-58%), and 23% (5.0-54%), respectively.

CONCLUSIONS: The final TRITON2 results confirm the clinical benefit and manageable safety profile of rucaparib in patients with mCRPC, including those with an alteration in BRCA or select non-BRCA DDR gene.

PATIENT SUMMARY: Almost half of TRITON2 patients with BRCA-mutated metastatic castration-resistant prostate cancer had a complete or partial tumor size reduction with rucaparib; clinical benefits were also observed with other DNA damage repair gene alterations.

Original languageEnglish
JournalEuropean Urology
Volume84
Issue number3
Pages (from-to)321-330
Number of pages10
ISSN0302-2838
DOIs
Publication statusPublished - Sept 2023

Keywords

  • DNA Damage
  • Genes, BRCA2
  • Humans
  • Indoles/therapeutic use
  • Male
  • Prostatic Neoplasms, Castration-Resistant/drug therapy
  • Metastatic castration-resistant prostate cancer
  • Poly(ADP-ribose) polymerase inhibitor
  • DNA damage repair gene alteration

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