Neeraj Agarwal, MD, shares key takeaways from TALAPRO-2

Data from the phase 3 TALAPRO-2 trial (NCT03395197) showed that the combination of enzalutamide (Xtandi) plus talazoparib (Talzenna) led to a statistically significant and clinically meaningful improvement in overall survival (OS) vs enzalutamide alone in patients with metastatic castration-resistant prostate cancer (mCRPC).¹ These data were presented at the 2025 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium in San Francisco, California.

In a recent interview with Urology Times®, Neeraj Agarwal, MD, FASCO, shared the key take-home messages for urologists based on data from this trial.

“TALAPRO-2 is the first PARP inhibitor plus ARPI combination study to show a statistically significant and a clinically meaningful improvement in overall survival vs an active control of enzalutamide in our patients with metastatic CRPC,” he stated. “The benefit was present [in the] all-comer patient population, as well as [in] patients who were selected for [the] presence of HRR gene mutations.”

Agarwal is professor of medicine and the director of the genitourinary oncology program at the Huntsman Cancer Institute of the University of Utah in Salt Lake City.

Specifically, data from the trial showed a median OS of 45.8 months (95% CI, 39.4 to 50.8) in the combination arm vs 37.0 months (95% CI, 34.1 to 40.4) in the enzalutamide monotherapy arm (HR, 0.796; 95% CI, 0.661 to 0.958; 2-sided P = .0155). OS favored the combination among patients who were HRR-deficient (n = 169; HR, 0.549; 95% CI, 0.364 to 0.826; P= .0035) and among those who were HRR–non-deficient/unknown (n = 636; HR, 0.878; 95% CI, 0.713 to 1.080; P = .218).

Additionally, the median radiographic progression-free survival among all patients was 33.1 months in the combination arm vs 19.5 months in the enzalutamide monotherapy arm (HR, 0.667; 95% CI, 0.551 to 0.807; P < .0001).

Based on these findings, Agarwal concluded, “These data support the use of talazoparib plus enzalutamide as a standard of care initial treatment option for our patients with mCRPC. I really hope this option is brought up during the discussion we have with our patients when they are starting treatment with enzalutamide.”

REFERENCE

1. Agarwal N, Azad A, Carles J, et al. Final overall survival (OS) with talazoparib (TALA) + enzalutamide (ENZA) as first-line treatment in unselected patients with metastatic castration-resistant prostate cancer (mCRPC) in the phase 3 TALAPRO-2 trial. Presented at: 2025 American Society of Clinical Oncology Genitourinary Cancers Symposium. San Francisco, California. February 13-15, 2025. Abstract LBA18