ASCO GU 2026 Highlights: Patient-Reported Outcomes with Capivasertib in Prostate Cancer Patients

Описание: E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, San Diego, California, welcomes Daniel J. George, MD, FASCO, Director of Genitourinary Oncology and Professor of Medicine and Surgery, Duke Cancer Institute, Durham, North Carolina. Their discussion highlights results from the CAPItello-281 trial in metastatic hormone-sensitive prostate cancer defined by PTEN deficiency.

Dr. George presents findings from a randomized trial involving 1,000 patients with at least 90% PTEN loss. Patients received androgen deprivation therapy (ADT) and abiraterone with either the AKT inhibitor capivasertib or a placebo. The primary endpoint was radiographic progression-free survival.

The study demonstrates a median radiographic progression-free survival of 25 months in the control arm compared with 33.7 months in the capivasertib arm, representing a 7.5-month improvement. Increasing degrees of PTEN loss correlate with progressively worse outcomes in the control arm and proportionally greater relative benefit from AKT inhibition.

A notable finding is the high rate of radiographic progression without a rise in prostate-specific antigen (PSA). Approximately two-thirds of patients develop castration-resistant disease without PSA progression, underscoring the aggressive and biologically distinct nature of PTEN-deficient disease. Symptomatic skeletal events, including cord compression and pathologic fractures, are more frequent in this population.

Patient-reported outcomes using the Functional Assessment of Cancer Therapy–Prostate instrument demonstrate a transient decline in physical well-being during the first six weeks, corresponding to early toxicities including rash, diarrhea, and hyperglycemia. Functional well-being remains stable. Discontinuation rates for these adverse events are low.

The discussion emphasizes PTEN immunohistochemistry testing as a scalable, practical method for identifying high-risk patients who may benefit from targeted therapy.

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