PD-1/PD-L1 for prostate cancer: from clinical trials to practice

INTRODUCTION: A growing number of malignancies have shown favorable responses to immune checkpoint inhibitors (ICI), most commonly anti-PD-(L)1 antibodies. However, prostate cancer has been associated with mostly unfavorable responses to ICI. This review discusses various trials related to PD-(L)1 inhibitors in prostate cancer. AREAS COVERED: We wrote a review article based upon content and practice expertise supplemented with review of the literature. The focus was on PD-1 or PD-L1 inhibitors in prostate cancer. EXPERT OPINION: Clinical trials with PD-(L)1 inhibitors in patients with prostate cancer administered alone or in combination with other therapies do not appear to have significant benefit in unselected patients, whether part of initial systemic therapy or after the development of hormone resistance. However, there may be benefits in selected tumors harboring mutations with microsatellite instability high/mismatch repair deficiency (MSI-H/dMMR) and, to a lesser extent, high tumor mutational burden (TMB-H). While only a small percentage of prostate tumors have these mutations (MSI-H/dMMR: 3%) and (TMB-H: 4.5%), panel genomic testing can help identify subsets of patient populations who may benefit from PD-(L)1 inhibitors in addition to other molecularly selected agents.