Prospects regarding novel therapeutics for prostate cancer within the field of genomic medicine

In June 2019, targeted next-generation sequencing was approved for health insurance in Japan, and cancer genomic medicine began. In prostate cancer, the therapeutic landscape is expected to change significantly due to targeted next-generation sequencing. Various genetic abnormalities are identified by targeted next-generation sequencing, but it is expected that only about 15% of cases can be treated for such abnormalities, and the development of novel treatments based on genomic abnormalities is required in the future. Poly ADP-ribose polymerase inhibitors have shown a promising outcome in cases with abnormalities in homologous recombination repair genes. In addition, pembrolizumab (PD-1 inhibitor) as a treatment for solid tumors with microsatellite instability and entrectinib (TRK inhibitor) as a treatment for NTRK fusion gene-positive solid tumors were approved for health insurance. Moreover, umbrella-type and basket-type clinical trials for inhibitors targeting a variety of cancer driver gene abnormalities are currently ongoing. Although many problems exist within the field of genomic medicine, the insurance approval of targeted next-generation sequencing is expected to serve as a trigger to greatly advance cancer medicine in Japan.