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Niraparib Plus Abiraterone Acetate and Prednisone for Metastatic Castration-Resistant Prostate Cancer With HRR Gene Alterations
Final Analysis of the Phase 3 MAGNITUDE Trial

Featuring Elena Castro, MD, PhD

11/01/2023

Elena Castro, MD, PhD, Hospital Universitario 12 de Octubre, Madrid, Spain, discusses the final analysis of the phase 3 MAGNITUDE trial. This study compared niraparib plus abiraterone acetate and prednisone (AAP) with placebo plus AAP among patients with metastatic castration-resistant prostate cancer (CRPC) and homologous recombination repair (HRR) gene alterations.

In this trial, Dr Castro stated, “we have seen an overall survival benefit from the combination [of abiraterone plus niraparib] for patients with BRCA1 and BRCA2 mutations." She added, "We should make the effort of identifying all our patients with BRCA mutations to offer them treatment with a PARP inhibitor as soon as possible."

These results were first presented by Kim Nguyen Chi, MD, BC Cancer and Vancouver Prostate Centre at University of British Columbia, Vancouver, British Columbia, Canada, at the 2023 European Society for Medical Oncology Annual Congress in Madrid, Spain.

Transcript:

Hi, my name is Elena Castro. I'm a medical oncologist at Hospital University 12 de Octubre in Madrid, Spain. At ESMO 2023, the final results of the overall survival of the MAGNITUDE study have been presented.

MAGNITUDE is a randomized phase 3 study that investigated the benefit of combining abiraterone and niraparib in first-line treatment of metastatic castration-resistant prostate cancer. Patients were screened for alterations in HRR genes. Those patients who presented at least 1 alteration in these genes were included in cohort 1, and patients without any alterations were included in cohort 2. Within each cohort, patients were randomized to receive abiraterone alone or in combination with niraparib. The primary objective of this study was radiographic progression-free survival.

A futility analysis of the study suggested no benefit from the combination in cohort 2, patients without HRR alterations, and that cohort was closed. For patients with alterations in HRR genes, the primary objective was met with a benefit in [radiographic progression-free survival] rPFS from the combination of niraparib and abiraterone. Those results have already been presented in prior meetings.

Now we have learned the final results of the overall survival analysis. In a meta-analysis that included different risk factor and accounted for some imbalances in the populations observed in the treatment and control arms, we have seen a benefit and overall survival benefit from the combination for patients with BRCA1 and BRCA2 mutations. This is very important because we know that these patients have very poor outcomes when conventionally treated with taxanes or hormonal agents that we use for the treatment of mCRCP patients.

I think from now on, we should make the effort of identifying all our patients with BRCA mutations to offer them treatment with a PARP inhibitor as soon as possible.

Source:

Chi KNN, Castro E, Attard G, et al. Niraparib (NIRA) with abiraterone acetate plus prednisone (AAP) as first-line (1L) therapy in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) and homologous recombination repair (HRR) gene alterations: Three-year update and final analysis (FA) of MAGNITUDE. Presented at 2023 ESMO Annual Congress; October 20-24, 2023; Madrid, Spain. LBA85

© 2023 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Oncology Learning Network or HMP Global, their employees, and affiliates.

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