mCRPC Treatment: From the Editor
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Primary Tumors Can Tell Us More If We Ask Them To
As a medical oncologist, I may rely a little less than my radiation or urology colleagues on the Gleason score for prognosis and treatment decision making. Most of our decisions are based on the pace of disease and extent, and of course whether it is castration-resistant or castration sensitive. However, I do look at it and in particular, it factors into the data ‘stew’ that one creates within an individual case and how we approach it.
Early, Earlier, Earliest (Docetaxel)
Chemotherapy improves survival when given to patients prior to radical prostatectomy.
It is the latest, and potentially the last, piece of data in the decades-long march of this important and interesting (but much-maligned) therapy. Will this news change practice?
ATM: Time to Withdraw?
The clinical development of therapies targeting DNA repair pathways in prostate cancer is now well underway. It is a hopeful on-ramp for prostate cancer into the world of molecular oncology. We are beginning to see the emergence of consistent data and some surprises. There is a significant reason for hope, for example, that the poly ADP ribose polymerase (PARP) inhibitors will become a standard of care for patients with BRCA1 or BRCA2 alterations.
How Do We Play This CARD?
A highly practical and interesting study, CARD, was recently presented at ESMO and published in the NEJM. It’s a study that answers a lot of questions, creates a few others, and can be translated into the clinic relatively quickly.
The CARD study randomized patients with castration-resistant prostate cancer (CRPC) to either treatment with cabazitaxel ( taxane chemotherapy) or a second ‘sequence’ of androgen receptor (AR) targeted therapy (ARTT) – enzalutamide in patients with prior abiraterone exposure, or vice versa.
Minding the Gaps in Prostate Cancer Treatment
Communication with patients is always a challenge, as is gathering all the information you need to make an informed decision. Then there’s the energy and time that are required to keep up with the clinical literature in your space, and the scientific/basic literature of it if you are so inclined.
Hormone Sensitive Metastatic Disease. The Glass is 25-33% Empty
Preserve! Prevent! Prolong! (Embrace these as the goals of care)
1. Dear Surgeons - stop telling patients “We got it all” signed, Medical Oncologists.
2. Dear Medical Oncologists – please inform your patients that your treatments for metastatic disease are palliative, not curative. Signed, Surgeons and Radiation Oncologists.
What Should We Do with the Exceptional Responders?
Small Cells, Big Worries
The Year in mCRPC – an Unobjective Look at Some of 2018’s Best Papers
RB, or Not RB: That is the Question!
Apollo 14 and the Lessons from Fractures
In Search of the Ultimate Cause of Cancer Death and Survival
My institution, the University of Minnesota, recently launched a “Medical Discovery Team on the Biology of Aging” a program that brings together clinicians,
The Positive in the Negative
Or, I might be working on the design of the phase III study of BEZ235 in mCRPC, or the use of AMG-102 plus mitoxantrone in patients following docetaxel for mCRPC.
New Metastatic Prostate Cancer? First, Take a Deep BREATH
Abiraterone + Enzalutamide: Is it Love or just a PLATOnic Relationship? - Charles Ryan
How Do We Know When What We are Doing isn't Working? - Charles Ryan
Landmarks, Surrogates and Strategies for Accelerating Clinical Trial Results - Charles Ryan
Good Abi, Bad Abi - Charles Ryan
Genomically Guided Therapy for Prostate Cancer. Promise Unfulfilled, Misguided or too Early to Call? - Charles Ryan
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