Dr. Ryan moved on and discussed the three P’s of the goal of care. Framing pre-therapy discussions can help patients understand all that an effective therapy can do for them, and also help in the selection of patient timing. The 3 P’s include:
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- Preserve (quality of life, performance status)
- Prevent (pain prevention, complications, and decline in performance status)
- Prolong life
Figure 1: Disease Burden and Benefit from Docetaxel:
The next topic discussed by Dr. Ryan was whether different variants drive specific therapies. Aggressive variant PC (AVPC) are a subset of PCs that share the clinical therapy response and molecular profiles of the small cell PC. This is a histopathological variant of the disease, that responds poorly to androgen receptor (AR) directed therapy. In AVPC there are combined tumor suppressor defects, and >-2 alteration in TP53, RB1, and/or PTEN.
In summary, Dr. Ryan tried to give several take-home messages on who should be treated with abiraterone and docetaxel. Abiraterone should probably be received by older, black race, lower disease burden, and intent for radiation patients. In contrast, docetaxel should be given to fitter, younger man, with higher disease burden.
Presented by: Charles Ryan, The University of Minnesota, Minneapolis, MN, USA
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter: @GoldbergHanan at the 2018 ASCO Annual Meeting - June 1-5, 2018 – Chicago, IL USA