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Highlights from the 2023 American Society of Clinical Oncology Annual Meeting
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| A Study of Prospective Monitoring of Patients with Recurrent Prostate Cancer Using Serial 18F-DCFPyL PSMA Imaging
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| Mohammad O. Atiq, MD
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| Mohammad Atiq discusses a study of prospective monitoring of patients with recurrent prostate cancer using serial 18F-DCFPyL PSMA imaging. 18F-DCFPyL PSMA PET imaging is now FDA approved for patients with high-risk prostate cancer (based on data from the OSPREY trial) and those with biochemically recurrent prostate cancer (based on data from the CONDOR trial).
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| ARAMON: A Phase 2, Randomized, Open-Label Study Comparing the Effects of Darolutamide Versus Enzalutamide Monotherapy on Serum Testosterone Levels in Patients with Hormone-Naive Prostate Cancer |
| Xin Gao, MD |
| The objective of ARAMON is to compare the effect of darolutamide and enzalutamide monotherapy on post-treatment testosterone levels in patients with hormone-naive prostate cancer experiencing biochemical recurrence after definitive treatment for localized disease. |
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| A Feasibility Study of 177Lu-PSMA Radioligand Therapy Alternated with Radium-223 in Patients with Bone-Metastatic, Oligo-Metastatic, Hormone-Sensitive Prostate Cancer After Curative Therapy: The DUET Study |
| André Vis, MD, Ph.D.
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| André Vis presents the results of DUET, a feasibility study evaluating 177Lu-PSMA radioligand therapy alternated with radium-223 in patients with oligometastatic hormone sensitive prostate cancer with bone metastases following curative therapy. |
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| APPROACH Trial: Multimodal Approach in Patients with mHSPC: A Pragmatic, Randomized, Phase 3 Trial of Androgen-Deprivation Therapy plus Apalutamide Versus ADT plus Apalutamide and Local Treatment—Meet-URO 29 Study |
| Valentina Guadalupi, MD
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| Valentina Guadalupi presents the results of the APPROACH trial, a pragmatic, randomized phase 3 trial that evaluates the addition of local treatment to ADT plus apalutamide in patients with metastatic hormone sensitive prostate cancer.
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| PSMA PET Guided Salvage Radiotherapy Among Patients with Prostate Cancer in the Post-Prostatectomy Setting: A Single Center Post-Hoc Analysis
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| Jeremie Calais, MD, MSc |
| Jeremie Calais presents the results of a single center post-hoc analysis evaluating PSMA-PET/CT-guided salvage radiotherapy among patients with prostate cancer in the post-prostatectomy setting. This analysis demonstrates that PSMA-PET/CT-guided salvage radiotherapy is an effective method for treating both locoregional and distant recurrences. Further investigation is needed to assess the full extent of patient outcomes in this population. |
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| PSMA Ligand PET Disease Extent and Overall Survival in Patients with High-Risk Nonmetastatic Castration-Resistant Prostate Cancer: An International Multicenter Retrospective Study |
| Boris A. Hadaschik, MD
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| In this study, the presence of PSMA-detected polymetastatic disease (5+ lesions) was significantly associated with worse overall survival outcomes. Findings on PSMA-PET/CT may prove as prognostic markers of survival outcomes in nmCRPC patients undergoing PSMA-PET imaging. Further validation studies in this space are required.
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| Do Bone Scans Over-Stage Disease Compared to PSMA PET? an International Multicenter Retrospective Study with Blinded Independent Readers |
| Wolfgang Fendler, MD |
| Wolfgang Fendler presents the results of an international, multicenter retrospective study evaluating whether bone scans over-stage metastatic burden, compared to PSMA-PET/CT, using blinded independent readers. In this multicenter retrospective study, the PPV of bone scans was low in patients at initial staging, with the majority of positive bone scans being false positives. |
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| Discussant: Looking for Prostate Cancer: Will Novel Imaging Light the Way?
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| Louise Emmett, MBChB, FRACP
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| Louise Emmett discusses the current and future states of novel imaging modalities for advanced prostate cancer. PSMA PET is an imaging biomarker that will be the new gold standard for prostate cancer, with no role for bone scans. PSMA PET is effective at triaging those patients requiring more intense systemic treatments at biochemical recurrence, nmCRPC is a multi-faceted entity in the era of PSMA PET.
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| Health-Related Quality of Life and Pain Outcomes for Patients with mCRPC Who Received Abiraterone and Olaparib Vs Abi and Placebo in the Phase III PROpel Trial |
| Andrew J. Armstrong, MD |
| Based on this study, it appears that the use of combination abiraterone plus olaparib, compared to abiraterone alone, is not associated with worsening of HRQoL outcomes, as assessed by the FACT-P total and subscale scores, BPI-SF domain, and worst pain scores. This suggests that patients can derive rPFS benefits from this combination while maintaining a similar HRQoL. |
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| Patient-Reported Outcomes Among Men Receiving Talazoparib + Enzalutamide vs Placebo + ENZA as First-Line Treatment for mCRPC: Results from a Phase 3 Study (TALAPRO-2)
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| Neeraj Agarwal, MD |
| Compared with placebo/enzalutamide, the combination of talazoparib + enzalutamide may be associated with modest improvements in global health status and quality of life, although the differences were not clinically meaningful; otherwise, all functioning scale scores were similar across both arms. This study is limited by the secondary nature of the PRO endpoints, with no adjustments for comparison multiplicity performed and the poor post-treatment completion rates, limiting assessment of PROs in the post-treatment setting. |
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| Patient Reported Quality of Life and Survival Outcomes: Analysis of ECOG-ACRIN E3805 Chemohormonal Androgen Ablation Randomized Trial (CHAARTED) in Prostate Cancer |
| Daniel Sentana Lledo, MD |
| Daniel Sentana Lledo presents an updated analysis of CHAARTED evaluating patient-reported quality of life and survival outcomes in metastatic hormone-sensitive prostate cancer patients. FACT-P assessed 3-month QoL score was prognostic of OS outcomes in mHSPC patients from the CHAARTED trial. Patients with the lowest QoL (i.e., "most symptomatic”) appeared to experience improved OS outcomes with combination ADT + docetaxel, independent of disease volume.
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| Discussant: Quality in the Context of Quantity: Evaluating Treatment Intensification |
| Ravi Amrit Madan, MD |
| Ravi Madan discusses quality in the context of quantity: evaluating treatment intensification. Dr. Madan highlights, Patient-reported quality of life and survival outcomes from the CHAARTED trial, patient-reported outcomes in TALAPRO-2, and health-related quality of life and pain outcomes from patients in the PROpel study. |
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| PANTHER: A Prospective Trial of Apalutamide and Abiraterone Acetate plus Prednisone in Black and White Men with mCRPC |
| Daniel J. George, MD |
| This study hypothesized that treatment with the combination of apalutamide + abiraterone + prednisone may result in clinical efficacy in Black men with mCRPC. Black patients were underrepresented in the phase III ACIS trial. Further studies of apalutamide + abiraterone + prednisone combination therapy among Black men with advanced prostate cancer are needed to determine potential clinical benefits in this understudied population. |
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| Primary Analysis of STARTAR: A Phase 2 Salvage Trial of ADT and Apalutamide with Radiation Therapy Followed by Docetaxel in Men with PSA Recurrent Prostate Cancer After Radical Prostatectomy
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| Tian Zhang, MD
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| In this first phase 2 trial of ADT, apalutamide, salvage radiotherapy, and 6 cycles of docetaxel for high risk PSA recurrence, the primary endpoint 3-year progression free survival rate improved to 72%, indicating durable remissions beyond historic controls. All but one patient recovered testosterone by 3 years (median time 15 months), with the majority of patients remaining PSA progression free with full testosterone recovery.
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| Discussant: Right Treatment, Right Setting for Systemic Therapy |
| Joaquin Mateo, MD, Ph.D. |
| Joaquin Mateo discusses the right treatment in the right setting for systemic therapy. Dr. Mateo highlights two abstracts including “PANTHER: A prospective trial of apalutamide and abiraterone acetate plus prednisone in Black and White men with mCRPC” presented by Dr. Daniel George, and “STARTAR: A phase 2 salvage trial of androgen receptor inhibition with ADT and apalutamide with radiation therapy followed by docetaxel in men with PSA recurrent prostate cancer after radical prostatectomy” presented by Dr. Tian Zhang. |
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