Amol Akhade, Senior consultant medical oncologist and hemato-oncologist at Suyog Cancer Clinics and Reliance Hospitals, posted on X:
“Treatment Sequencing:
ASCO 2025 mCRPC Guideline Update. What’s new in sequencing? Let’s break it down! Post-ADT only.
• BRCA1/2+: PARPi+ARPI combo (Talazoparib/Enza, Olaparib/Abi)
• HRR−: Abi/Enza or Docetaxel
• Bone-only: Add Radium-223
• MSI-H: Pembrolizumab
After ARPI
• BRCA+: Olaparib
• HRR−: Docetaxel > Cabazitaxel
• Avoid 2nd ARPI due to cross-resistance
Post-Docetaxel
• ARPI or Cabazitaxel
• BRCA+: continue PARPi
• MSI-H: Pembrolizumab
After Triplet (ADT+ARPI+Docetaxel)
• PSMA+: 177Lu-PSMA-617
• BRCA+: Olaparib or Rucaparib
• HRR−: Cabazitaxel or Radium-223
• Consider platinum for aggressive variants.”
Title: Systemic Therapy in Patients With Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update.
Authors: Rohan Garje, Irbaz Bin Riaz, Syed Arsalan Ahmed Naqvi, R. Bryan Rumble, Mary-Ellen Taplin, Terry M. Kungel, Daniel Herchenhorn, Tian Zhang, Kathryn E. Beckermann, Neha Vapiwala, Michael A. Carducci, Paul Celano, Sebastien J. Hotte, Arnab Basu, Hala Borno, Alan H. Bryce, Peng Wang, Elizabeth Wulff-Burchfield, Lisa Bodei, Andrew Loblaw, Robert J. Hamilton, Hamid Emamekhoo, Thomas A. Hope, Huan He, M. Hassan Murad, Hongfang Liu, James Elbert Williams Jr, Rahul A. Parikh
Read The Full Article at Journal of Clinical Oncology.
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