How do you manage de novo high volume mCSPC with both BRCA2 mutation and MSI-H on somatic testing?
When (if ever) would you consider immune checkpoint inhibitor up front? Would you be less inclined to offer triple drug therapy? (Some thought that taxane may diminish the efficacy of CPI). How would you sequence future therapies when a patient inevitably has progression on an ADT+ARSI doublet?
Answer from: Medical Oncologist at Academic Institution
This is a very rare but interesting scenario. Presumably in this case, the BRCA2 mutation is a passenger event in the setting of high TMB as a result of MMRD/MSI high disease, which has been reported. Typically these BRCA alterations are monoallelic and the tumors lack homologous repair deficiency a...
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