The growing role of rucaparib in contemporary treatment of metastatic prostate cancer: a review of efficacy and guidance for side effect management

Introduction: In May 2020, the approval of rucaparib–a poly-ADP-ribose polymerase (PARP) inhibitor–in the USA marked the arrival of a new class of targeted therapeutics for a subset of metastatic castration-resistant prostate cancer patients whose tumors harbor germline or somatic BRCA1/2 gene alterations. It has now become critical for physicians to be aware of the role and nuances of management of PARP inhibitor therapies in prostate cancer. Areas covered: We focus on rucaparib’s pharmacology, key clinical trials that support its current indication, the competitive landscape, and our considerations for management of adverse events. We also review the ongoing clinical trials that may expand its utility in prostate cancer in our expert opinion. Finally, we discuss the opportunities that exist for further development of this class of targeted agents in prostate cancer. Expert opinion: We believe that the time has come to develop functional assays of HRR proficiency or deficiency in order to better guide PARP inhibitor selection for patients with prostate cancer and beyond.