[Molecular tumor board prostate cancer]

Area of Science:

• Oncology
• Genetics
• Pharmacology

Background:

• Molecular tumor boards are crucial for integrating clinical research and healthcare in oncology.
• Metastatic prostate cancer patients, especially those with family history or advanced disease, may benefit from molecular profiling.
• Biomarkers like AR-V7 and DNA repair mutations are emerging for treatment selection.

Purpose of the Study:

• To highlight the role of molecular tumor boards in optimizing treatment for metastatic prostate cancer.
• To discuss the clinical significance of AR-V7 expression and DNA repair mutations.
• To explore the potential of targeted therapies, including PARP and PD-1 inhibitors, in prostate cancer.

Main Methods:

• Interdisciplinary expert assessment of molecular testing appropriateness.
• Review of clinical trial data and biomarker associations.
• Discussion of therapeutic options based on molecular profiling.

Main Results:

• Androgen receptor splice variant 7 (AR-V7) predicts resistance to next-generation androgen receptor-directed therapies.
• Homologous recombination defects in DNA repair pathways sensitize tumors to PARP inhibitors (e.g., olaparib).
• DNA mismatch repair deficiency/microsatellite instability may predict response to PD-1 inhibitors (e.g., pembrolizumab).

Conclusions:

• Molecular profiling identifies actionable targets in metastatic prostate cancer.
• Biomarker-guided therapy, including off-label use of PARP and PD-1 inhibitors, shows promise.
• Molecular tumor board recommendations are essential for insurance coverage of biomarker-matched treatments.