A 72-year-old man with metastatic castration-resistant prostate cancer (mCRPC) progresses after docetaxel chemotherapy. Genomic testing reveals a pathogenic BRCA2 mutation. The MOST appropriate next-line therapy is:
- A Olaparib (PARP inhibitor) ✓
- B Cabazitaxel
- C Radium-223
- D Sipuleucel-T immunotherapy
Explanation
The PROfound trial demonstrated that olaparib (a PARP inhibitor) significantly improves radiographic progression-free survival and overall survival in mCRPC patients with homologous recombination repair (HRR) gene mutations, including BRCA1/2. BRCA2 mutations confer the greatest benefit from PARP inhibition due to synthetic lethality. Cabazitaxel is a second-line chemotherapy option but lacks specific efficacy for HRR-mutated disease. Radium-223 is for symptomatic bone-only metastases and improves survival but is not the best option in a genomically selected population with BRCA2 mutation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.