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ENZAMET, Overall Survival Results of a Phase III Randomized Trial of Standard-of-care Therapy with or without Enzalutamide for mHSPC, an ANZUP-led International Cooperative Group Trial
Testosterone suppression is the backbone of treatment for mHSPC, however, until 2014, testosterone suppression +/- standard nonsteroidal antiandrogen was the only therapy available. In this study, men with mHSPC were randomly assigned 1:1 to receive testosterone suppression plus either enzalutamide or a non-steroidal anti-androgen.
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Intensified Up-front Therapy for Prostate Cancer: The Revolution Continues with ENZAMET
The presentation of ENZAMET by Dr. Christopher Sweeney was followed by Dr. Tanya B. Dorff of City of Hope Cancer Center who provided a discussion of this phase 3 trial demonstrating an overall survival benefit for enzalutamide vs non-steroidal anti-androgen among men with mHSPC. Following Dr. Sweeney’s presentation, ENZAMET was immediately published in the New England Journal of Medicine.
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Androgen Targeted Therapy: Is More Better?
Michael Carducci provided a discussion on the “First results from TITAN: A phase III double-blind, randomized study of apalutamide versus placebo in patients with metastatic castration-sensitive prostate cancer receiving ADT”, “Decreased fracture rate by mandating bone-protecting agents in the EORTC 1333/PEACE III trial comparing enzalutamide and Ra223 versus enzalutamide alone: An interim safety analysis”, and “Alliance A031201: A phase III trial of enzalutamide (ENZ) versus enzalutamide, abiraterone, and prednisone (ENZ/AAP) for metastatic castration resistant prostate cancer (mCRPC)”. He highlights three main points to take away from these abstracts.
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Uses for PSMA Diagnostics and Therapeutic Approaches in Localized Disease: A Urologist's Perspective
Dr. Robert Evan Reiter gave a Urologist’s perspective on the use of PSMA in localized prostate cancer. He began his presentation stating the importance of imaging in all stages of prostate cancer. To date, imaging has not changed management, but new technology raises new clinical management dilemmas, and we still need to decipher how PSMA-PET should alter management in specific conditions, and most importantly, whether it improves disease outcomes at all.
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Defining Oligometastatic Disease: Shifting Definitions and Potential Effects on Patient Outcomes
Dr. Ted Schaeffer discussed the definition of oligometastatic prostate cancer and its potential effects on patient outcomes. The “relaxation” in screening recommendation 2008 and 2012 has changed the scope of whom we are now seeing with prostate cancer, resulting in more men with an advanced disease being diagnosed.
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Pembrolizumab plus Enzalutamide in Abiraterone-Pretreated Patients with mCRPC: Cohort C of the Phase 1b/2 KEYNOTE-365 Study
Pembrolizumab has activity as monotherapy in patients with heavily pretreated advanced mCRPC. The mechanism of action of pembrolizumab and enzalutamide might be synergistic, leading to increased antitumor activity, compared with either agent alone. Dr. Peter Fong and colleagues presented data from KEYNOTE-365 cohort C (pembrolizumab plus enzalutamide), a phase 1b/2 umbrella study for men with mCRPC.
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Prospective Head-To-Head Comparative Phase 3 Study Between 18F-Fluciclovine and 68Ga-PSMA-11 PET/CT in Patients with Early Biochemical Recurrence of Prostate Cancer
Two PET/CT imaging tests for detection and localization of prostate cancer tumor sites in patients with biochemical recurrence have been introduced recently: 18F-fluciclovine PET/CT targeting the upregulated amino acid transporter activity, and PSMA PET/CT targeting the over-expression of the transmembrane prostate specific membrane antigen via its extracellular molecule. Jeremie Calais and colleagues presented results of a prospective single-center, single-arm, blinded, head-to-head phase 3 study of paired 18F-fluciclovine and 68Ga-PSMA-11 PET/CT scans for localizing early biochemical recurrence of prostate cancer after radical prostatectomy.
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Education Session - All Men Are Created Equal: Addressing Disparities in Prostate Cancer Care
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More Than Skin Deep: Investigating Disease Biology, Treatment Response, and Side Effect Differences by Race
Dr. Dan George gave a presentation on the race differences in prostate cancer. There are significant health disparities among racial groups with prostate cancer. The mortality rates also vary in the US, with the south-east section showing a greater rate of mortality compared to the rest of the US. This geographical area also has a higher rate of African-American ancestry than other areas in the US.
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From Trials to Treatment: Addressing Disparities in Access to Prostate Cancer Care
Dr. Hala Borno presented on the disparities in access to prostate cancer care in the United States. The incidence of prostate cancer in the US has been decreasing over time. Additionally, the treatment paradigm in this era of precision medicine has changed significantly, in each disease stage of prostate cancer, with the use of genomics, molecular imaging and clinical trials.
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Elephant in the Room: Financial Toxicity in Cancer Care
Dr. Lowell Schnipper gave a presentation on the financial toxicity aspect of cancer care. In recent years, there have been new and promising cancer therapies demonstrating improved results in some diseases. However, there is still a long way to go in many other cancers, with only marginal gains attained with these novel therapies. Importantly, the cost of these novel drugs, treatments, and services continue to rise exponentially, making it quite unaffordable in most of the world. By 2020 the US cancer cost is estimated to be 173 billion dollars.
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Disparities in Prostate Cancer Across the Cancer Continuum
Silke Gillessen also presented on the topic of disparities in prostate cancer focusing on disparities globally and across the cancer continuum. The incidence and mortality of prostate cancer vary widely between countries.
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