Lack of Consensus Identifies Important Areas for Future Clinical Research: Advanced Prostate Cancer Consensus Conference (APCCC) 2019 Findings

Background: Innovations in treatments, imaging, and molecular characterisation have improved outcomes for people with advanced prostate cancer; however, many aspects of clinical management are devoid of high-level evidence. At the Advanced Prostate Cancer Consensus Conference (APCCC) 2019, many of these topics were addressed, and consensus was not always reached. The results from clinical trials will most reliably plus the gaps.

Methods: An invited panel of 57 experts voted on 123 multiple-choice questions on clinical management at APCCC 2019. No consensus was reached on 88 (71.5%) questions defined as <75% of panelists voting for the same answer option. We reviewed to identify relevant ongoing phase III trials in these areas of non-consensus.

Results: A number of ongoing phase III trials were identified that are relevant to these non-consensus issues. However, many non-consensus issues appear not to be addressed by current clinical trials. Of note, no phase III but only phase II trials were identified, investigating side effects of hormonal treatments and their management.

Conclusions: Lack of consensus almost invariable indicates gaps in existing evidence. The high percentage of questions lacking consensus at APCCC 2019 highlights the complexity of advanced prostate cancer care and the need for robust, clinically relevant trials that can fill current gaps with high-level evidence. Our review of these areas of non-consensus and ongoing trials provides a useful summary, indicating areas in which future consensus may soon be reached. This review may facilitate academic investigators to identify and prioritise topics for future research.

Ursula M. Vogl,a Tomasz M. Beer,b Ian D. Davis,c Neal D. Shore,d Christopher J. Sweeney,e,aa Piet Ost,f Gerhardt Attard,g Alberto Bossi,h Johann de Bono,i Charles G. Drake,j Eleni Efstathiou,k Stefano Fanti,l Karim Fizazi,m Susan Halabi,n Nicolas James,o Nicolas Mottet,p Anwar R. Padhani,q Mack Roach,r Mark Rubin,s,ab Oliver Sartor,t Eric Small,r Matthew R. Smith,u Howard Soule,v Matthew R. Sydes,w Bertrand Tombal,x Aurelius Omlin,ac,1 Silke Gillessen,a,y,z,ad,1 on behalf of the APCCC 2019 expert panel.2

a. Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; b. Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; c. Monash University and Eastern Health, Victoria, Australia; d. Carolina Urologic Research Center, Myrtle Beach, SC, USA; e. Dana-Farber Cancer Institute, Boston, MA, USA; f. Radiation Oncology, Ghent University Hospital, Ghent, Belgium; g. University College London Cancer Institute, London, UK; h. Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France; i. The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Surrey, UK; j. Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA; k. University of Texas MD Anderson Cancer Center, Houston, TX, USA; l. Policlinico S.Orsola, Università di Bologna, Italy; m. Institut Gustave Roussy, University of Paris Sud, Villejuif, France; n. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA; o. The Institute of Cancer Research, London, UK; p. University Hospital Nord, St Etienne, France; q. Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK; r. UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; s. Bern Center for Precision Medicine, Bern, Switzerland; t. Tulane Cancer Center, New Orleans, LA, USA; u. Massachusetts General Hospital Cancer Center, Boston, MA, USA; v. Prostate Cancer Foundation, Santa Monica, CA, USA; w. MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK; x. Cliniques Universitaires Saint Luc, Brussels, Belgium; y. University of Bern, Bern, Switzerland; z. Università della Svizzera Italiana, Lugano, Switzerland; aa. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; ab. Department for Biomedical Research, University of Bern, Bern, Switzerland; ac. Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; ad. Division of Cancer Science, University of Manchester, Manchester, UK.

Source: Vogl U., Beer T., Ian D. Davis I. et al "Lack of consensus identifies important areas for future clinical research: Advanced Prostate Cancer Consensus Conference (APCCC) 2019 findings." European Journal of Cancer. 2021. 0959-8049.
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