The Side Effects of Advanced Prostate Cancer Consensus Conference 2019 (APCCC) - Silke Gillessen and Aurelius Omlin

September 2, 2019

In advanced prostate cancer, rapid and successful drug development has resulted in multiple treatment options that require careful decision-making for individual patients. Clinicians face the increasingly difficult task of choosing from multiple potentially effective treatments that also are costly and potentially toxic. Further developments in novel next-generation imaging methods, biomarkers, molecular characterization, and genetic assays have led to many open questions and areas for which there is sparse or low-level evidence to support clinical decision-making.

The Advanced Prostate Cancer Consensus Conference (APCCC) was initiated to provide a forum to discuss and debate current questions on the clinical management of men with advanced prostate cancer, with a special focus on these unclear situations. The Advanced Prostate Cancer Consensus Conference convened August 29 - 31, 2019 in Basel Switzerland. The Advanced Prostate Cancer Consensus Conference (APCCC) provides an update on the current standard of advanced prostate cancer management and a global discussion on questions that occur in daily clinical practice for which there is limited evidence-based data.

In this video, Silke Gillessen and Aurelius Omlin join Neal Shore, Alicia Morgans, and Charles Ryan for a closing conversation after the 2019 Advanced Prostate Cancer Consensus Conference (APCCC).


Silke Gillessen, MD, Professor and Chair in Genitourinary Oncology Systemic Therapy Research at The University of Manchester and The Christie NHS Foundation Trust, Co-founder of the Advanced Prostate Cancer Consensus Conference (APCCC)

Aurelius Omlin, MD, is a professor at the Kantonsspital St. Gallen, Medical Oncology Consultant Department of Oncology/Haematology and Cantonal Hospital St.Gallen (Prof. Th. Cerny) and a 2013 ASCO Merit Award and a member of SAKK (Schweizerische Arbeitsgruppe für Klinische Krebsforschung), ESMO (European Society of Medical Oncology), ASCO (American Society of Clinical Oncology) and FMH (Swiss Medical Association).

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.

Neal Shore, MD, FACS is the Medical Director of the Carolina Urologic Research Center. He practices with Atlantic Urology Clinics in Myrtle Beach, South Carolina. He serves on several industry advisory boards as well as academic and advocacy networks: including the Society Urologic Oncology Clinical Trials Consortium, Bladder Cancer Advocacy Network, and the Large Urology Group Practice Association. 

Alicia Morgans, MD, MPH, Associate Professor of Medicine in the Division of Hematology/Oncology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. 

Read the Full Video Transcript

Neal Shore: We've just concluded the third APCCC, the Advanced Prostate Cancer Consensus meeting in Basel, Switzerland. A fantastic meeting, and it's a great pleasure to introduce the two co-chairs and the organizers, the founders of APCCC.

I'm also here with two great colleagues and friends, Chuck Ryan and Alicia Morgans, but without further ado, we have Silke Gillessen and Aurelius Omlin. You guys, great meeting. Fabulous. Kudos. You did an amazing, amazing job. This is the meeting that everyone wants to not only go to but then read about afterwards. So, fantastic. Maybe just a little review again about how it all started and how you've gotten to where we are today.

Silke Gillessen: Yes, we have talked about that already, right? But I think a lot of people ask me now again, so it's really... In 2013 or about, we were thinking... So, there's a St. Gallen meeting for early breast cancer, but why don't we have one for prostate cancer? Because I mean, there's enough questions that are still open or there's no good evidence.

But again, the breast cancer people are ahead of us with everything. And we naively decided to just start up such a consensus meeting. I guess we both a bit underestimated the work it takes to do such a meeting and organize such a meeting. But it was a lot of fun. And we started in 2015 and as you know, 2017 was the second one, and this year is the third one.

And I think we also learn. We improve phrasing of the questions, but also the panel has increased. The audience has increased a lot. We started with about 300, then it was like 500 and now it was over 700 participants, audience coming. So, I think it's nice. So, it seems that also other people have the impression that there is expert meaning, expert opinions needed in these questions where we don't have good evidence.

Aurelius Omlin: What we usually do is what we did from the very first one, and what we learned from breast cancer. We identified 10 areas where we think are the most unanswered questions. They haven't actually changed that much from 2015 to this time. Like bone and bone metastasis are still a hot topic.

But I think where we have improved is this time when we voted today on the questions, actually, all the questions have been targeted by talks on Thursday and Friday by the experts, and we learned a lot. And I think a lot of the panel members were in the audience as well and commented on that and said they learned something new on their management in daily practice.

Chuck Ryan: You said something today which is really interesting, which is, we had one of the questions, we had a 94% agreement and you said, well, that question will go off now. We've solved that problem more or less. That's pretty much uniform agreement. So, we don't need to debate that. That topic will not be presented at the next meeting. And it's interesting. I was wondering how many topics were there in the last meeting that didn't make it to this meeting because we agree. Or, are there any that where we didn't agree last time and now we agree?

Silke Gillessen: Yeah. So, I guess it always a bit depends, I think, what we could do is if there's no new data coming, obviously.

Chuck Ryan: Right.

Silke Gillessen: And we have such a-

Chuck Ryan: It won't happen.

Silke Gillessen: In some of the questions, and there is clear consensus, that's a question we decided that doesn't have to come up again, right? Because we have already consensus, there is no new data that would influence any of us to change our opinion. So, we're going to leave that out because there's enough questions, right? We started off with 150. We had to reduce just because it's not doable, but we want really to focus on the questions that we think are important and it's not completely clear that the consensus is there anyway.

Aurelius Omlin: Then, there's actually a topic like the health status assessment in the elderly patients that we discussed in 2017, reached no consensus and I think it was even worse today. Looking at the answer options, I don't know them on top of my head, but it's clearly no consensus to do something even a simple G8 screening in the over 70 year olds.

Chuck Ryan: Yeah. I think that partly people were a little stymied by that question because they thought, well I don't have a geriatrician to send them to. Or, they think, well, I can do this myself. And so, I think that might be something we want to tease out in the future.

Alicia Morgans: Yeah, I think that one from my perspective was a lot about the official standardized instrument, and was not necessarily about making sure the obvious... whether those characteristics in a patient or those factors regarding a patient's health would actually be assessed. But that's the case for a lot of these questions, that where we find a lack of consensus, we may dig more in a future meeting.

And I think that that's what we so look forward to seeing, because one of the benefits of a meeting like this is that you identify these areas of no consensus, and then we can come together in a few years, review the new data and the data we have now, and really update ourselves and each other about that.

And one of the things that I loved, and we all have done talks at this meeting, and a lot of us actually have done areas that are sort of adjacent to what we normally do, but are also new places for us to think about. And Chris Logothetis mentioned that when he was giving his talk, but you're helping us all stretch and grow, which helps give fresh eyes and fresh minds, I think, to these questions and problems, which I also find fascinating.

Chuck Ryan: Yeah. I actually really like that as a feature of this, that a lot of us are speaking on things that we don't speak on normally.

Alicia Morgans: Yes.

Aurelius Omlin: So, we call that the side effects of APCCC, talking about things that you're not... Because we have so many experts, not everyone can talk about ABI and ENZA, right?

Alicia Morgans: No, of course.

Aurelius Omlin: We have to find people who talk about other things. And the other thing is what we discussed. What we want to write up is the side effect paper of the areas where we have not reached consensus. Where should we invest our money in for research, resources?

Chuck Ryan: I was going to say I think that's really one of the amazing things about your effort in doing this. It started out as a relatively small meeting in St. Gallen. The reach of APCCC is global now, and you really extend it now to all continents. It's really fantastic.

And you think about unmet educational needs. What really struck me at the meeting this year was just on genetic testing. How we're really at the beginning of the beginning, and yet there's soon going to be an avalanche of potential combining biomolecular testing with therapeutics and just additional cascade familial genetic testing.

I was struck at how there was nowhere near a consensus. And then, that plus NGIs, Novel Imagings. It's really more than anything next-generation imaging. And I think that's just so exciting to see how this is going to change the field and how we do things.

Silke Gillessen: Yeah. I mean, I agree with Alicia. I think for me it's like almost two things, where there is this one probably part where we should try to get more granularity in some of the questions to make clearer what is the problem, why do people not use it even if it's recommended everywhere. And then also, we have this other part that Aurelius mentioned, that we have some really deep gaps where even experts don't know what to do, and we should really think about trials in these indications.

So, for me, it's almost like two faults, things that we could do. So, why are easy things like the G8, for example, not used? How could we try to make that better in normal life? And the other thing is really, there is some areas where we need to clinically trying data. 

Chuck Ryan: Right.

Silke Gillessen: And I thought that is interesting.

Chuck Ryan: I was also wondering about the shiny new objects that come out. The new... Like in this case, it would've been Lutetium, I guess. It was the one where everybody wanted to give Lutetium, right? And that's because a lot of us don't have firsthand experience using it yet, and we don't quite understand the limitations.

We understand the upside and I think that that's also... We're also going to get a chance to look at the evolution of how things happen, which is when they first come out, people are genuinely really excited and then they begin to lose their enthusiasm because reality sets in side effects, et cetera.

Alicia Morgans: So, such a good point though about that were the comments around PSMA testing, and whether it's next-generation or if it's now. And I think that there was a lot of comment around caution and making sure that we have the data to back up what we're actually doing.

And I don't remember hearing such a strong voice in that direction, actually. Even two years ago, it was more of the shiny object, actually two years ago, and it remains shiny. But I think maybe we're becoming a little less enamored, and we're getting some brains behind it, which is encouraging.

Neal Shore: So, a lot of shiny things came out of this meeting. I think we're all enamored with the two of you. You've raised the bar for all of us at meetings. I mean, this is hands down. Everyone wants to come to this meeting.

Chuck Ryan: The two shiniest objects.

Neal Shore: Yeah. And so, we're all very excited. We know that your work hasn't ended. The paper will come out. You'll get it out at breakneck speed. I don't know how you'll do it. Everyone will be really excited to see the paper. We're all going to help with it.

And again, we can't thank you enough. Another fantastic week. And then, I'd be remiss if I didn't say in two years from now the APCCC will be in Lugano, Switzerland.

Silke Gillessen: Yes, right. Beginning of October, 7th to 9th of October for everyone who wants to come. And we also have really to thank the panelists again. Fantastic talks and what you mentioned, I think, is like... They even did the talks that they normally don't do.

It's much more difficult to do a new talk instead of just taking all the old slides you have from your old talks anyway and just put them together. And I think that is really work and people did it. And also the revision of the questions. I mean, the panel was fantastic as well. I mean, really, I think it really goes up and down with the panelists as well.

Aurelius Omlin: Well, we do varieties in the invitation letter. If you sign up for this conference-

Silke Gillessen: It's work.

Aurelius Omlin: It involves quite a lot of work. I don't think everyone realizes what they actually sign up for, but I think the end result is worth it. Also having all the talks recorded that will be available online, and having lots of interviews with experts, patient representatives and hearing the voice around the globe.

Silke Gillessen: Yes and thanks to the interviewers as well.

Neal Shore: So, with that, I think for all of us, it was a great pleasure, great fun. If you call this work, then we'll do this every day. Anyway, thanks very much.

Alicia Morgans: Thank you.

Silke Gillessen: Thank you.

Chuck Ryan: Thank you.

Aurelius Omlin: Thank you.
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