Editor's Note: The 2024 European Society for Medical Oncology (ESMO 2024) Annual Meeting took place from September 13 to 17 in Barcelona, Spain. The team led by Dr. Yao Zhu from Fudan University Shanghai Cancer Center presented their research on the neoadjuvant treatment of localized high-risk prostate cancer, featuring a combination of ARSi and PARPi, which was selected for poster presentation (1625P). In an exclusive interview with Urology Frontier, Dr. Yao Zhu shared insights into how their research is contributing to the global understanding and treatment of prostate cancer, showcasing China’s expertise in this field.Abstract No.: 1625P
Fuzuloparib combined with abiraterone in the neoadjuvant treatment of localized high-risk prostate cancer (FAST-PC): A single-arm phase II study
In the FAST-PC trial (NCT05223582), 35 patients with high-risk or very high-risk prostate cancer received neoadjuvant treatment with a combination of fuzuloparib and abiraterone. Following treatment, 3 patients achieved a pathologic complete response (pCR), while 13 met the criteria for minimal residual disease (MRD), leading to a combined pCR/MRD rate of 45.7%. After a median follow-up of 19.7 months, patients who achieved pCR/MRD demonstrated a longer median biochemical progression-free survival (bPFS). However, 17.1% of patients experienced grade 3 or higher treatment-related adverse events (TRAEs), including one case of grade 4 drug-induced liver injury. Additionally, 8.6% of patients developed grade 3 anemia. These findings suggest that the combination of PARPi and ARSi in neoadjuvant therapy significantly improves the pCR/MRD rate, with a safety profile consistent with that of monotherapy. Molecular analyses of pre- and post-treatment samples are currently underway to further explore the mechanisms underlying this efficacy.
Dr. Yao Zhu:This study demonstrates that the combination of neoadjuvant fuzuloparib and abiraterone in patients with localized high-risk prostate cancer achieved a pCR/MRD rate of 45.7%. This is a notable improvement compared to the efficacy of ARSi monotherapy, indicating that the combined use of PARPi and ARSi could offer a new strategy for enhancing the outcomes of neoadjuvant treatment. Patients who achieved pCR/MRD had a significantly longer median bPFS (not reached vs. 10.8 months, P=0.046), suggesting a potential positive correlation between pathologic response and subsequent survival, offering valuable insights for monitoring and assessing treatment efficacy in clinical practice.
Although some grade 3 or higher TRAEs were observed, the overall safety profile was consistent with the known characteristics of each drug, indicating that the safety of the combination therapy is within a manageable range. Future studies could optimize the dosing and treatment regimen to further reduce adverse events. Ongoing molecular analyses are expected to provide critical insights into biomarkers and mechanisms, aiding in the refinement of treatment strategies.
However, it is important to recognize that while the results of this phase II FAST-PC trial are promising and offer a new perspective for the treatment of localized high-risk prostate cancer, further randomized controlled trials are needed to validate the long-term efficacy and safety of this combination therapy. Additionally, exploring the role of different biomarkers to identify patients who will benefit the most from this combined treatment will be a key focus of future research. We look forward to further studies that will deepen our understanding and application of this therapeutic strategy.
Dr. Yao Zhu
Dr. Yao Zhu is a Chief Physician, Professor, and Doctoral Supervisor at the Urology Department of Fudan University Shanghai Cancer Center, where he also serves as the Deputy Director for Administrative Affairs (responsible for Urology in the Pudong branch). He is the Vice Chairman of the Youth Council of the Chinese Anti-Cancer Association and the Secretary-General of the Chinese Society of Clinical Oncology Prostate Cancer Expert Committee. He has been recognized as a top talent under the Shanghai Oriental Talents Program and is an Outstanding Academic Leader in Shanghai, as well as a Distinguished Professor at Shanghai’s universities under the Oriental Scholar program. He is also a member of the Shanghai “Medical Star” program for outstanding young medical talents.
Professor Zhu specializes in the early diagnosis and radical treatment of prostate cancer, particularly the precision treatment of refractory prostate cancer. He performs over 400 radical prostatectomies annually and has pioneered precision imaging-guided extended radical prostatectomies and salvage surgeries for recurrent prostate cancer in China. His primary research interests include the precision diagnosis and treatment of prostate cancer resistance. Over the past five years, he has published influential papers as corresponding author in European Urology, Med, Journal of NCCN, Clinical Cancer Research, and EJNMMI. He has also been invited to write reviews for Nature Reviews Urology, including a 2021 article on precision classification and treatment strategies for prostate cancer in Asia, and a 2024 review on the biology and clinical management of prostate cancer liver metastasis.
As a project leader, Professor Zhu has secured five National Natural Science Foundation grants and has been recognized with awards such as Shanghai Youth Science and Technology Star, Fudan University’s Top Ten Youth, the Fudan and Shanghai Municipal Health Commission’s Youth May Fourth Medal, and Fudan University’s “Top Ten and Top Hundred” Outstanding Young Doctors.
