Neoadjuvant Therapy for Men with High Risk Disease Prior to Prostatectomy - Mary-Ellen Taplin

(Length of Conversation: 19 min)

Mary-Ellen Taplin, MD has a discussion with Dr. Alicia Morgans on the topic of neoadjuvant therapy for men with high risk disease prior to surgery, specifically, prior to prostatectomy.  Neoadjuvant therapy combined with radiation therapy is a well affirmed standard of care for prostate cancer.  Talking about systemic therapies prior to prostatectomy particularly for men with high risk localized prostate cancer,  Dr. Taplin believes there is no standard systemic therapy that should be given neoadjuvent to prostatectomy. When patients receive this treatment at her facility it is always in the context of a clinical trial. 

Dr. Alicia Morgans highlights the importance of studying neoadjuvant chemotherapy and hormonal therapies in clinical trials before it is being used more broadly in everyday clinical practice which Dr. Mary-Ellen Taplin agrees with as she reviews several clinical trials affirming this, that have spanned a time of 10-15 years.  Studies which have shown that there is no known benefit in terms of PSA relapse or any other relevant clinical endpoint such as survival or radiographic endpoints for standard androgen deprivation therapy prior to prostatectomy. She advices references these trials and shying away from prescribing standard hormone therapy before prostatectomy as there is well known downsides to androgen deprivation therapy. 

Dr. Alicia Morgans emphasizes patient selection, ensuring you have the highest risk patients which may have the highest benefit from the therapy and combination therapy which Dr. Mary-Ellen Taplin elaborates on by summarizing phase II trials of second generation androgen receptor pathway antagonist drugs her team has been working on, drugs such was aberaterone and enzalutimide and apalutimide.  Drugs in these trials have been focused on men with have high risk for relapse with prostatectomy alone.  She also overviews her talk “Newly Diagnosed High-Risk Disease Treatment: Summarizing Neoadjuvant Trials” which she presented at the ASCO GU 2018 and concluded that based on the current data, there is a subset of men who will achieve an outstanding pathological response after neoadjuvant ADT, however better biomarkers are needed to determine which men will have a good response.

They briefly discuss the ICECaP, and study Dr. Mary-Ellen Taplin completed with Rana McKay on testosterone recovery  after androgen deprivation therapy.  The length of therapy in this trial was not longer than 6 months and with a medium patient age of 50 years.  Among the trials they discussed was also the PUNCH trial which is scheduled to conclude later this year.  This will be the only phase III clinical trial in the current era which will show the outcomes of neoadjuvant treatment prior to prostatectomy and is the last large phase III trial, in  high risk localized prostate cancer, which started 11 years ago.

Dr. Mary-Ellen Taplin feels strongly against treating with chemotherapy alone prior to prostectomy and she shares several other treatments in the neoadjuvant vs adjuvant setting for both prostate and bladder cancers.

Alicia Morgans, MD, MPH

Mary-Ellen Taplin, MD is a medical oncologist in Boston, Massachusetts and is affiliated with multiple hospitals in the area, including Brigham and Women's Hospital and Dana-Farber Cancer Institute. She received her medical degree from University of Massachusetts Medical School and has been in practice for more than 20 years.  She completed a residency in internal medicine and chief residency at the University of Massachusetts Medical Center and an oncology-hematology fellowship at Beth Israel Hospital and Harvard Medical School. 
Dr. Taplin was on staff in medical oncology-hematology as an assistant and then associate professor of medicine at the University of Massachusetts from 1993 to 2003, when she joined Dana-Farber Cancer Institute.

Read More Related Content:

A Presentation by Mary-Ellen Taplin at the 2018 ASCO GU Meeting: Newly Diagnosed High-Risk Disease Treatment: Summarizing Neoadjuvant Trials

Watch: Over-treatment in the Name of Cure: Revisiting Adjuvant Therapy in the Modern Era? - Christopher Sweeney