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NCCN Flash Updates: NCCN Guidelines Updated for Prostate Cancer

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium^®) for Prostate Cancer. These NCCN Guidelines^® are currently available as Version 4.2023

Link directly to the Updates section of the NCCN Guidelines: Prostate Cancer

PROS-15

No prior docetaxel/no prior novel hormone therapy:
- Useful in certain circumstances:
  - Added: Niraparib/abiraterone for BRCA mutation (category 1)
Prior docetaxel/no prior novel hormone therapy:
- Useful in certain circumstances:
  - Added: Niraparib/abiraterone for BRCA mutation
  - Added: Olaparib/abiraterone for BRCA mutation
Prior novel hormone therapy/no prior docetaxel:
- Useful in certain circumstances:
  - Category modified: Talazoparib/enzalutamide for HRRm (category 2B)
  - Added: Niraparib/abiraterone for BRCA mutation (category 2B)

PROS-15A

Footnote qqq modified: Olaparib with abiraterone is an option for patients with a pathogenic BRCA1 or BRCA2 mutation (germline and/or somatic) who have not yet received a novel hormone therapy ~~or docetaxel~~and who have not yet had treatment in the setting of CRPC.
Footnote yyy modified: Talazoparib plus enzalutamide is a treatment option for patients with metastatic CRPC and a pathogenic mutation (germline and/or somatic) in a homologous recombination repair gene (BRCA1, BRCA2, ATM, ATR, CDK12, CHEK2, FANCA, MLH1, MRE11A, NBN, PALB2, or RAD51C) who have not yet had treatment in the setting of CRPC, depending on prior treatment in other disease settings (see PROS-15). There may be heterogeneity of response based on the specific gene mutation. (See Discussion). Use of talazoparib/enzalutamide for those who have received prior novel hormone therapy is controversial because a benefit of this combination over use of a PARP inhibitor alone has not been shown in this setting, but responses are likely.
Added footnote zzz: Niraparib plus abiraterone (combination tablet) is a treatment option for patients with metastatic CRPC and a pathogenic BRCA1 or BRCA2 mutation (germline and/or somatic) who have not yet had treatment in the setting of metastatic CRPC, depending on prior treatment in other disease settings (see PROS-15). Use of niraparib/abiraterone for those who have received prior novel hormone therapy is controversial because a benefit of this combination over use of a PARP inhibitor alone has not been shown in this setting, but responses are likely. The fine-particle formulation of abiraterone can be given with single-agent niraparib as a substitute for the combination niraparib/abiraterone tablet (category 2B; other recommended option).

PROS-J 2 of 3

Targeted therapy
- 3rd bullet modified: Olaparib with abiraterone is an option for patients with a pathogenic BRCA1 or BRCA2 mutation (germline and/or somatic) who have not yet received a novel hormone therapy ~~or docetaxel~~ and who have not yet had treatment in the setting of CRPC.
- 4th bullet modified: Talazoparib plus enzalutamide is a treatment option for patients with metastatic CRPC and a pathogenic mutation (germline and/or somatic) in a homologous recombination repair gene (BRCA1, BRCA2, ATM, ATR, CDK12, CHEK2, FANCA, MLH1, MRE11A, NBN, PALB2, or RAD51C) who have not yet had treatment in the setting of CRPC, depending on prior treatment in other disease settings (see PROS-15). There may be heterogeneity of response based on the specific gene mutation. (See Discussion). Use of talazoparib/enzalutamide for those who have received prior novel hormone therapy is controversial because a benefit of this combination over use of a PARP inhibitor alone has not been shown in this setting, but responses are likely.
- 5th bullet added: Niraparib plus abiraterone (combination tablet) is a treatment option for patients with metastatic CRPC and a pathogenic BRCA1 or BRCA2 mutation (germline and/or somatic) who have not yet had treatment in the setting of metastatic CRPC, depending on prior treatment in other disease settings (see PROS-15). Use of niraparib/abiraterone for those who have received prior novel hormone therapy is controversial because a benefit of this combination over use of a PARP inhibitor alone has not been shown in this setting, but responses are likely.

MS-1

The following discussion sections have been updated to reflect the changes in the algorithm:
- Metastatic castration-sensitive prostate cancer
- Non-metastatic CRPC
- Metastatic CRPC

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps.

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