mCRPC Treatment: From the Editor
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PARP Inhibitors, Prostate Cancer and a Promise Fulfilled
June 26, 2020, marked the 20th anniversary of the publication of the first working draft from the Human Genome Project. At a special White House event to commemorate the results of this 10-year public effort (it was really more like 50 years since the discovery of DNA, but I digress), then-President Bill Clinton called the project “the most wondrous map ever created by humankind”, and touted its promise to detect, prevent, and treat disease. Obtaining that first sequence from one human cost about $2B and resulted from a massive global public/private partnership.
Is This the HERO We Need?
Another advance in hormonal approaches to controlling prostate cancer is available for our consideration. The results of the HERO trial demonstrate efficacy and safety advantages of oral relugolix when compared to standard of care leuprolide, given via intramuscular injection every three months. The results open up two areas for discussion: 1) is an oral ADT feasible, effective and necessary and 2) do LHRH antagonists confer cardiovascular and disease control benefits compared to LHRH agonists? It provides us with choice and a lot to ponder in terms of how this treatment may alter patient outcomes, practice patterns, and the future of our approaches to many stages of prostate cancer.
Targeting the AR: Have We Reached the Outer Limits?
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?
How Do We Know When What We Are Doing Isn't Working?
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