Onkológia 5/2020

Immunotherapy in prostate cancer

Prostate cancer belongs to immunologically “cold” malignancy with limited response to immunotherapy. The role of immunotherapy in prostate cancer has to be defined, while incorporation of checkpoint inhibitors to therapeutical combinations appear to be a promising way, bringing optimism to the treatment of prostate cancer, as well. In the last decade, huge advances in therapeutical options prolong survival in patients with metastatic castrate-resistant prostate cancer (mCRPC), such as modern androgene deprivation therapy (ADT), targeted therapy or radiotherapy. In the immunotherapy era, promising data show enhanced activity of checkpoint inhibitors in combinations with ADT. Multiple results from clinical studies, point out the possible effectiveness of combinations of checkpoint inhibitors with therapeutical vaccines, hormonal therapy, radiation, PARP inhibitors, or chemotherapy. First therapeutical vaccine, Sipuleucel- T approved for the treatment of mCRPC as well as pembrolizumab in MSI-H or dMMR progressive metastatic castrate-resistant prostate cancer. Nivolumab, pembrolizumab or ipilimumab monotherapy did not bring expectable results in the treatment of unselected mCRPC. On the other hand, promising data with the combinations of anti PD-1/PD-L1 or anti-CTLA-4 antibodies together with DNA vaccines, based on the results of preclinical studies, show possible augmentation of immune response in combination with chemotherapy, radiopharmaceutics or PARP-inhibitors. The therapeutical goal with immunotherapy in prostate cancer, probably will be the modification to indolent course rather then complete eradication of advanced disease, with focusing of good quality of life for patients.

Keywords: prostate cancer, castrate-resistant, immunotherapy