SAN FRANCISCO, CA USA (UroToday.com) - Dr. Maha Hussain, MD, FACP presented on advances, in the last decade, in the treatment of metastatic prostate cancer.
With regards to hormone sensitive metastatic prostate cancer, she focused her talk initially on the question of intermittent versus continuous androgen deprivation therapy (ADT). She discussed that this question was one of the most tested, with multiple phase III trials over the past decade. She summarized the SWOG 9346 trial, which failed to demonstrate non-inferiority of intermittent ADT with a 7-month survival difference when compared to continuous ADT. She then went on to discuss the question of whether the addition of chemotherapy to initial ADT had an impact on survival. She presented the CHAARTED trial which compared docetaxel with ADT, to ADT alone, and found a survival advantage in the docetaxel arm.
She then turned her attention to developments in the treatment of metastatic castration-resistant prostate cancer (mCRPC). She discussed that prior to 2004, the treatments for mCRPC, that had been FDA approved, focused mainly on palliation. Since the approval of docetaxel in 2004, however, multiple therapies that result in an improvement in survival in mCRPC have been developed. She reviewed the docetaxel, cabazitaxel and sipuleucel-T studies. She emphasized the continued importance of androgen signaling in CRPC, proven through survival benefits demonstrated with administration of abiraterone and enzalutamide. She also reviewed the radium 223 trial, which also demonstrated a survival benefit as well as an increased time to an initial symptomatic skeletal event.
Despite all of these new options in the treatment of mCRPC, however, she emphasized the following “glaring deficiencies:”
- Improved survival in trials with these new agents meant a difference of 2 to 5 months in comparison to placebo;
- Treatment of mCRPC at this time lacks individualization in the form of predictive biomarkers and personalized targeted therapies.
She highlighted the opportunities for future advances in figuring out ways to maximize the effectiveness of therapies, particularly with regards to the appropriate sequence of therapy and the potential for combination therapy. She discussed the role of cost in therapeutic choice and emphasized the high cost of all the newly developed therapies and the need to balance that cost with their effect and their use in the last years of a patient’s life.
She concluded by applauding the progress that has occurred over the last decade, particularly in the treatment of mCRPC. She emphasized that metastatic prostate cancer demonstrates patient-to-patient heterogeneity and that development of future therapies relies on total understanding of the disease, with identification-validated targets and pathways. She discussed the importance of raising the standard for approval of therapeutics, in the future, beyond comparison to placebo alone and also reiterated the importance of the consideration of cost effectiveness.
Highlights of a presentation by Maha Hussain, MD, FACP at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
University of Michigan Health System, Ann Arbor, MI USA