Latin American Oncology Group (LACOG), a Cooperative Group Consensus - Fernando Maluf
August 14, 2019
Fernando Maluf, MD, Associate Director – Oncology Center - Beneficência Portuguesa, São Paulo Member of Steering Committee – Oncology Center – Albert Einstein Hospital, São Paulo
Charles J. Ryan, MD, the President and Chief Executive Officer of The Prostate Cancer Foundation (PCF), the world’s leading philanthropic organization dedicated to funding life-saving prostate cancer research. Charles J. Ryan is an internationally recognized genitourinary (GU) oncologist with expertise in the biology and treatment of advanced prostate cancer. Dr. Ryan joined the PCF from the University of Minnesota, Minneapolis, where he served as Director of the Hematology, Oncology, and Transplantation Division in the Department of Medicine. He also served as Associate Director for Clinical Research in the Masonic Cancer Center and held the B.J. Kennedy Chair in Clinical Medical Oncology.
Charles Ryan: Hello from ASCO 2019. I'm happy to be joined by my friend, Fernando Maluf, who I haven't seen in a while. We trained together in New York and he's now a leading oncologist, if not the leader of genitourinary oncology in Brazil. And you're doing some really exciting things, and I wanted to talk to you, Fernando, about the conference you're putting together, which will be in early 2020. It's a consensus conference. Tell us about who will be there and what the questions will be about?
Fernando Maluf: So, first of all, it's a pleasure to talk to you. I'm a part of a big oncology group in Latin America, called LACOG, is a Latin American Oncology Group, which is the first time, at least from what I've heard, is a cooperative group that is trying to put together all the experts in the diagnosis and in treating oncology patients. So, this big group, this cooperative group, developed a consensus that happened last December. Was a consensus with similar proposals to the APCCC, that has been going on for the third edition. This great consensus tried to get answers to three-quarters of the world that don't have all of the resources available.
So, we did this consensus last December. Was an eight hour consensus with almost 400 questions from the screening towards the late stage of prostate cancer, coming from every situation from the ideal world towards questions posing difficulties regarding not the best radiation therapy available, not all the drugs available and tried to find the answers from the experts that came from all over the world particularly for developing countries in Africa, Latin America, Middle East, to vote and to give the answers, to orient, to give some light to the doctors and all the health care providers that treat patients in places where, again, we have a very important resource limitations. We will come up with seven papers that, of course, we expect that, again, give a great impact to the whole world treating prostate cancer in places with difficulties.
Charles Ryan: That's terrific. So tell me, in the developing world, these three-quarters of the countries that don't have the resources that the other quarter have for the treatment of prostate, bladder, and other cancers, are you finding that you're looking for new ways to deliver older drugs? New combinations of older, generic chemotherapies, for example? Or are some of the new drugs that are being approved being used in a more creative fashion, a more cost-effective fashion? In other words, is it old drugs or new drugs?
Fernando Maluf: I think both. Many of the questions. We don't have abiraterone, enzalutamide, radium 223, cabazitaxel available so then we have to come up what to do with only the old drugs available.
Charles Ryan: Right.
Fernando Maluf: On the other hand, many questions you pose like different scheduling of the approved drugs but that couldn't be delivered in the full doses. An example is abiraterone. So many questions asked about what about the one-fourth of the abiraterone dose, is it a solution when you don't have the full abiraterone available or not? Also, we will come up with answers regarding radiation therapy, when you don't have IMRT, when you don't have conformal radiation and you're facing cobalt radiation therapy or surgery, what's the best way to go? So, we pose many, many questions with very interesting answers that will be published probably this year or the beginning of next year again in seven papers with all the different phases of the disease, give answers for initial. That is so important, but I don't think has been formally documented.
Charles Ryan: Right, fascinating. For example, abiraterone, you mentioned has recently gone generic in the United States. We haven't really seen a drop in the price or an increase in the availability of abiraterone. Has that changed made an impact at all in the developing world?
Fernando Maluf: Well, in Brazil it just has come, not the general abiraterone, the generic one. So, we don't know already the impact, but it probably will have a great impact, particularly for the public system. Again, the public system in Latin America is responsible for more than 75 to 85% of the patients. So, very few patients are linked to the private insurance programs. So, again we have to have a special look at this public population that is linking to the public system.
Charles Ryan: That's probably many hundreds of thousands of patients with urological cancers, I would imagine, in Brazil alone?
Fernando Maluf: And we will come up with solutions, so how to deliver the best way we can these drugs or the best radiation therapy available to this patient population, which again is the majority of the patient population.
Charles Ryan: Right. So, for viewers who are interested in your work and interested in this conference, when will they be able to get access to or how can they participate in finding out what is decided and how can they get information on what is learned at your conference?
Fernando Maluf: Well, we will have again seven papers to be published at the end of the year/beginning of next year. We will also have a set of slides for every question and every answer to be distributed to any doctor.
Charles Ryan: Great.
Fernando Maluf: So they can in lecture, in presentation post the results. Also, as the LACOG group, the Latin American Group also is studying how we can improve the outcome of patients with, I will say, orphaned diseases. So, we just started a trial of pembrolizumab with chemotherapy as first-line therapy for penile cancer, cancer that hasn't had a study of care so far in many many cases. Also having studied to watch the outcome of patients comparing the public patients versus the private patients ...
Charles Ryan: Yeah, interesting.
Fernando Maluf: With CRPC trying to compare the survival curves cancer and non-cancer related to see how is the different applies.
Charles Ryan: Yeah, really fascinating. Well, congratulations. This sounds like a great event, and I hope I can learn from it and maybe be a part of it. That will be really wonderful to see the result of what you're doing there, and it's been a real pleasure to follow your career from afar and stay friends across continents. So, thank you for joining us today, Fernando.
Fernando Maluf: And you're officially invited to the next conference, which is the second biggest GU conference all over the world. It's just behind the ASCO GU.
Charles Ryan: Right.
Fernando Maluf: Which is going to be happening on April 2- 4th and you're invited during this interview.
Charles Ryan: Sounds great, very good, looking forward to it.
Fernando Maluf: Thank you.