Zachary Klaassen: Thanks so much, Alicia. Zach Klaassen, Urologic Oncologist in Augusta, Georgia, and delighted to be part of this discussion. Super important as we start to implement this new treatment into our practices.
Alicia Morgans: Wonderful. Thanks so much. And Brenda Martone.
Brenda Martone: Hi, I'm Brenda Martone. I'm a GU Oncology Nurse Practitioner. And I'm excited to be here and talk about this new treatment and how we can make changes in our prostate cancer patients' long-term outcomes.
Alicia Morgans: Wonderful. Thank you so much. And Kara Cossis.
Kara Cossis: Hi. Good evening, everyone. My name is Kara. I'm a Physician Assistant. I am from Maryland working at Chesapeake Urology. I've been treating prostate cancer patients now for, gosh, a long time, 15 or so years. And it's exciting to have another tool in our tool belt to kind of push the treatment early on in their disease pathways.
Alicia Morgans: Great. Thank you so much. And last but not least, Christina Lee.
Christina Lee: Hi, everybody. I'm Christina Lee. I'm a PA. I'm located in Lakewood, Colorado. I work closely with my doc, managing advanced prostate cancer patients. And we have lots of clinical trials ongoing, and we're always looking to be on the cutting edge of the newest and best therapies to take care of our patients.
Alicia Morgans: Great. Well, as you can see, we have people here who are representing from all across the country and all actually quite high volume centers to help us understand how to best care for patients with this new treatment opportunity. Today's conversation is meant to focus on that practical implementation of this new therapy. We're going to do less data review and more thinking through how do we get the testing needed to use this treatment and identify the patients who are going to benefit most.
How do we keep patients on therapy and manage their side effects and do that proactively, so that they are able to stay on therapy? And know what's coming so that they're not concerned by the things that they are experiencing and have great communication with their care team. But before we get started, I think it's going to be really important for us to understand this patient population and to understand why PTEN loss is actually an important prognostic indicator, what that means in terms of the prognosis of the prostate cancer that's affecting our patients.
And it would be great if, Zach, you could level set by explaining that PTEN deficiency and also just walking us through CAPItello-281. What are the highlights here in terms of that clinical trial and some of the adverse events that we just need to think about?
Zachary Klaassen: Alicia, thanks so much. PTEN deficiency really is an important aspect to treating our prostate cancer patients. What this is, it's activation when we get deficiency of the PI3K/AKT pathway. This leads to robust cell growth, loss of regulation in survival metabolism. These are the bad actors for the prostate cancer patients that we see. And what's really important is, this is alternative pathways to traditional androgen receptor signaling.
We see this with advanced stage disease. It leads to shorter time disease progression and reduced benefit from our current standard of care treatment. So this is the patients where most patients we see with metastatic hormone-sensitive prostate cancer, we may say they do well for three, five, even up to 10 years now. These are patients that are having really poor outcomes in a lot shorter period of time.
When we think about this combination blockade, there's a lot of preclinical models that have gone through this. We've seen benefit in the mCRPC setting. And so, it's really important to look at this new trial. And this is a quick trial design. I'll go through this quickly. This was looking at Capi (Capivasertib) plus Abi (Abiraterone) plus ADT (androgen deprivation therapy) versus placebo plus ADT and Abiraterone. And so when we look at this, a big trial randomization one-to-one, patients had to have PTEN deficiency.
This was by immunohistochemistry. And you can see the primary endpoint here was investigator assessed radiographic progression-free survival. And so this was a positive trial. So this was a big Herculean effort by the trial teams to get these patients with the PTEN deficiency. And we see here a benefit hazard ratio of 0.81 favoring the Capi plus Abi arm, 95% confidence interval, 0.66 to 0.98. So a positive trial based on this endpoint.
Overall survival still very, very early in the follow-up in terms of the events. And so, we'll keep following this. And we're hopeful that there'll be an overall survival benefit as well. I want to point out one key secondary endpoint that was positive. Time to castration resistance. This had a hazard ratio of 0.77, and this is meaningful to patients. This means that there's likely going to be a need for a different treatment. Their disease has progressed beyond what they're already receiving. And so, this was a benefit in improving time to castration resistance with Capi plus Abi.
Finally, and we're going to discuss as Alicia mentioned, some of these common treatment-emergent adverse events. Ones we'll really specifically highlight today, diarrhea, hyperglycemia, and rash. And you can see here in the Capi plus Abi arm, the majority of these were about 50% for diarrhea, about one third of patients with hyperglycemia rash. And so, we'll go into some practical treatments for these. And really, again, implementation in the clinic. So I'll stop there, Alicia, and hopefully that level is set for our listeners.
Alicia Morgans: That's great. Thank you so much, Zach. And before we dive into all of that, I would just like to hear from your perspective. This is about 25% of our metastatic hormone-sensitive patient population or APMN or S as our new nomenclature would designate that. So these newly diagnosed patients. And so, that's not a small number. But I wonder, you said that this is a potentially particularly aggressive patient.
Patient's disease is going to be more aggressive, more commonly associated with the metastatic status. How important is it for urologists to think through this PTEN deficiency? And how do urology practices think about this and implementing testing for this, essentially, sort of newer disease entity within metastatic hormone-sensitive disease?
Zachary Klaassen: Yeah, it's a great question, Alicia. Thank you. I think these new patients are becoming... There's almost like a checklist of what we have to go through, right? And I think as sort of the gatekeepers to a lot of prostate cancer in the urology clinics, it's important to understand, yes, germline testing, somatic testing. So this is another checkbox in that list of PTEN loss immunohistochemistry, and I think communicating with our pathology colleagues.
And so because of that prevalence, it's important to understand that this has to be part of that. We have an opportunity with a biomarker-driven testing and treatment to really improve these patients' quality of life, longevity, radiographic progression-free survival. Hopefully, overall survival with further follow-up in this trial. But it's become a really important aspect when we see these new patients to really understand what their disease biology is.
Alicia Morgans: Yeah, I couldn't agree more. And I would just say, it wasn't in our level set. But there was an exploratory analysis that looked at the amount of PTEN loss that was reported. And the more PTEN that was lost, the worse the prognosis for the patient, so.
Zachary Klaassen: Yeah.
Alicia Morgans: And if we could give that individual the capivasertib-abiraterone combination, we could actually restore that patient's progression-free survival back up to the rest of the group. And it was, I thought, pretty incredible to see that. So absolutely, like you said, an opportunity, a responsibility to do this for our patients.
Before we jump into the toxicity monitoring, I wonder, Kara, from your perspective, what is your biggest takeaway from the CAPItello-281 data? And what would you say to your friends in terms of, and your colleagues at work, and of course to your patients, what's the big takeaway and how do you talk about this mechanism to those individuals?
Kara Cossis: Yeah, so I think that there's really stressing the importance of the severity of the disease and the progression associated with this loss. And so I think seeing the data that, like you and I mentioned, Dr. Klaassen like you're saying 10... You know? Whatever years. But knowing that it's a lot less, knowing that it's more aggressive. So I think really the education surrounds making sure that patients, not only when we're saying, "Okay." The checklist, right?
When we're saying, "Okay, we need to check to see if this is something that was inherited." We want to make sure that are there any other potential mutations there? And this is just one more checkbox that we want to say we need to monitor the possible aggressiveness of the disease, because there's treatments that weren't previously available that we can offer earlier on. So I think it can just be as simple as that.
I think if you try to get into the specifics of pathways and stuff... I mean, they're not going to understand. I think just keeping it simple. We're just trying to understand the aggressiveness disease because we want to prevent your disease from progressing more rapidly for as long as we're able to. And we have something that's available. So if we can do that, of course, we'd want to know that information.
Alicia Morgans: I agree. And it is exciting that this is another biomarker directed therapy. A therapy that can be personalized. Patients like when we can identify and go after a target. And this AKT PTEN pathway, I think gives us the opportunity to personalize to their prostate cancer, which is really important as people want to feel like individuals, even as they are going through this experience, which can be quite a common one.
Brenda, if you had to guess or to share some of the comments from patients in your practice, what questions do patients ask when they hear that they're going to potentially be tested for a biomarker directed treatment? Or what questions do they have about that treatment itself when they come to see you in clinic?
Brenda Martone: A lot of the questions are regarding, is this something that I'm going to pass on to my children? Versus germline versus somatic. Just sort of making sure they understand the difference between germline and somatic testing that we need to do both because there are some times that the tissue can have a mutation that germline may not show. And then, also I think letting them know that this is like biomarker testing that will occur throughout their prostate cancer kind of journey throughout treatment.
Because we do know sometimes with those with PTEN deficiencies, it may not develop right away. It's something that may occur in later stages as the disease progresses. So letting patients know this isn't... Germline's a one-time one and done, but somatic and PTEN might be something that's also revisited in the future to see if the prostate cancer cells have developed a mutation or a target mutation that we can target with a treatment such as Capi and Abi+Pred (Prednisone).
Alicia Morgans: Great. Thank you. Thank you for that. So I think it's clear. This is a really important thing for us to test for. We're going to get into the testing strategies in just a moment. But now, let's dive into that proactive management, patient education, counseling, talking about communication, and some of the more common adverse events. We did see this in the slide that Zach presented earlier, and we saw that there are relatively more common adverse events around things like diarrhea, rash, and hyperglycemia.
And although the Grade 3 and greater adverse event rates are not such that large numbers of patients were discontinuing for these adverse events, I think it's important for patients to proactively know what they can expect even if it is a lower grade, so that they can help us help them. And also to let them know this is related to the drug. You're not having some other illness, some GI illness, or some other adverse event that is unrelated.
And certainly, you need to tell us about that problem so we can get to the bottom of it, and decide drug related or infectious or something else. So let's start with diarrhea. This is one of the more commonly associated side effects as we just discussed. And Christina, I wonder what would you say to patients about this particular adverse event? How do they recognize it? When does it start? And what can they think about in terms of perhaps proactive management and communication with the team?
Christina Lee: Well, thank you for that. Yes, so diarrhea probably would be more apparent in the first week or so of starting the medication. I think as APPs, we have a strength as far as time with our patients and educating our patients. And I think a lot of that comes with taking a really good detailed history, knowing about their comorbid conditions that might apply to this, knowing about their baseline stool, and what those are like. And importantly, keeping a stool diary.
In fact, recommended to bring into every visit for at least three months, and to be very specific and outline for them what you're looking for. Frequency, consistency of the stool, if they have to be taking any agents, if they've had any dietary modification. So I think a lot of it it's going to be upfront as far as knowing your patient, knowing their baseline and informing them, okay, what is a grade two versus a Grade 3 diarrhea event when you notify us at each of these points?
And starting at the first loose stool with loperamide, some people might decide they want to start that proactively prophylactically in their clinics. And then just doing a regimen from there, modifying to BRAT diets, hydration. And then if it escalates to a grade two, then considering holding the dose until it goes back to grade one, and doing supportive measures, doing labs as clinically indicated, and so on and so forth.
Alicia Morgans: Yeah, I think that's great. So grade two being an increase of four to six stools per day. And so like you said, it is important to counsel people about that. I wonder, are there any warning signs? I mentioned infectious diarrhea. Especially this time of year, people are out and about. They're exploring in the woods or traveling to who knows where. Infectious diarrhea happens for sure. What are the warning signs that you would want to hear from a patient in addition to that stool diary? Are there things that you would want to know, "Hey, this is going on. I need to bring you in and do an additional assessment and workup."?
Christina Lee: Yep. So fever, severe abdominal cramping, signs of dehydration would all warrant more emergent action. Absolutely.
Alicia Morgans: Thank you for that. And I think this is one that can be bothersome. And we could sometimes use things like dose adjustments to help patients. But ensuring that we don't have an infectious diarrhea, and then starting things like Imodium can be really helpful to keep patients on the therapy that we know is going to be helpful for them.
So moving on, rash also something that we see sometimes with this drug. One of the adverse events that we want to be proactive about and talk with patients about. Kara, I wonder, can you share with us a little bit about rash? What are you thinking about in terms of identifying, communicating with patients? Are there things that they can do upfront even in advance of developing it that might be helpful in prevention or in just reducing the occurrence of the rash?
Kara Cossis: Sure. So we know that, basically, this pathway plays a role in the skin homeostasis, and so it could potentially lead to a rash. In the study, about 35% of patients did sustain a rash. So it's something we definitely need to be thinking about and something we want to educate our patients about. There's things that can be done proactively. And then if it does occur, consideration of stuff like dose interruptions or dose reductions.
But essentially, before the treatment would begin, like I said, we want to educate the patients that this is a possibility. And consider prophylaxing the patient with a non-sedating H1 antihistamine. And it's recommended, just depending on what you would choose, to do that once or twice a day. But you want to also make sure that the patients are monitoring themselves to look for a rash on their body surfaces. And if there is something that's happening outside of the antihistamines, there could be consideration of oral or systemic steroids.
And as I mentioned, dose modifications as needed. Also referring to dermatology early on, if there are any concerning findings is also recommended. Usually, the antihistamine for the first eight weeks is considered fairly essential. And then, continuing the antihistamine on a daily basis for the duration of the treatment is most optimal. And then, also a good skin emolene is good. And then there's this, I guess, an easy tool to remember. The palm of your hand including your fingers is equal to 1% of body surface. So just to use as a tool as far as the volume of the rash in order to help basically quantify what that looks like.
Alicia Morgans: Great. That is such helpful advice, especially this time of year, avoiding heat, sunlight, avoiding new soaps that could irritate the skin, new fragrances, and things like that. And just trying to be as gentle as possible, I think, with the skin. And then, reporting to the team if there's anything unusual. Certainly, if there are any warning signs like blistering, peeling rash, any mouth sores, any suspected infection over a rash, we would want to hear about it. And I usually tell patients, of course, we just want to hear from you to talk things through and make sure that nothing is going on that's going to be more intensive that we need to intervene upon. So that was wonderful. Thank you.
And let's move to the third adverse event that we need to really be thoughtful about here and just kind of proactively, again, communicate about. This one's hyperglycemia. And I think there are some pretty clear guidelines and some testing strategies to help us keep on top of this for our patients, and importantly, patients who do not have diabetes because they may not even have the understanding around blood sugar that those who do have diabetes have some comfort with. So Brenda, I wonder if you can share with us some of your thoughts around being proactive with hyperglycemia, how we educate our patients, how we monitor our patients, and how we think through some of the warning signs.
Brenda Martone: Yeah, I think a lot of our patients we all know come, not with just prostate cancer, but they have a lot of comorbid conditions. And so I think early on, just to piggyback off from the others, getting a good baseline assessment of the patients, and this actually includes a hemoglobin A1C. So in those patients who are not diabetic, getting a baseline hemoglobin A1C. And actually, there's some guidance to say if that hemoglobin A1C is 5.7 or higher, that might be a risk factor in those who don't have diabetes to develop some diabetes. Those with a high BMI greater than 30, so looking at that patient's weight.
And also, if they have elevated baseline glucose, fasting glucose. So this might be a patient when you're looking at all those things, if they have one of these risk factors, you might want to prophylactically initiate Metformin, and this can be 500 milligrams a day. And even starting one week before you initiate Capi. And then, again, making sure that you are assessing their GFR before you initiate Metformin and keeping an eye that if they do develop a GFR that's less than 30, you probably want to consider holding Metformin in these patients.
Along with the other side effects, there's kind of a predictable onset. And again, so getting these baseline labs, really explaining to the patient that this can happen at any time, can happen as frequently as in the first week or two of starting this medication or these combination treatments. And so, the rationale for monitoring the blood glucose levels more frequently. And again, this is quite frequent. And they may not be able to monitor these at home if they don't have an underlying diagnosis of diabetes type two. These patients aren't excluded from getting this treatment.
If they do have, and they may not be able to check this at home, so they may have to come in for labs, which patients aren't very excited about. It's more visits. But again, if they understand, I think the rationale for the close monitoring. Also, making sure patients are aware of what the signs and symptoms would be of high glucose such as if they develop excessive thirst, they're voiding excessively, they may feel more tired, they may get more hungry. So letting us know if those symptoms happen at any time after initiation of treatment.
And then again, there are guidelines. So if the fasting glucose is above 160, you're able to maintain the same dose. If you haven't initiated a prophylactic Metformin, you might want to start that at that point. If fasting glucose are above 160, there are some recommendations that maybe you want to withhold the dose of the Capi. And again, we know this isn't a sprint, it's a marathon. And letting patients know that if they do develop, just like any of the side effects, diarrhea, rash, we may have to withhold a dose just to let things kind of calm back down, and then re-initiate a dose.
And then depending on the grade or the severity of the hyperglycemia, dose may need to be reduced or they may be able to re-initiate it at the same dose. I think it's just, overall, having a good baseline, having a good conversation with patients. And even if they're not coming into the office, always being available to them, which I think NPs and PAs are always available. Encouraging them to reach out, or reaching out to them, and not waiting for them to report a symptom might make them feel a little bit more comfortable if they are having something.
I always tell patients I don't have a magic wand or a magic ball, so I can't see what's happening at home. But I tell them if they let me know, I'm 100% going to be able to help them manage their toxicity. And if they need to come in, I'm happy to see them. So I think good communication with the whole colleagues of the team, giving a good baseline education as everyone has really alluded to, I think really prepares the patient for more success.
Alicia Morgans: I couldn't agree more. And I think that this is one of the complications where I think partnership with primary care or perhaps even endocrine can be really helpful. And importantly, in CAPItello-281, patients didn't necessarily start the combination of capivasertib and abiraterone for the first 90 days. They had that window to enroll in the trial, and then get in there. And for the first 90 days of ADT, there was some flexibility, of course, to allow them to enroll. But this also, in clinic, reassures me that I can still get benefit. I don't need to start this immediately.
If I see a patient and I'm starting them on ADT and I am worried that their blood sugar's not controlled, that they're going to have a potential complication because of their BMI, because of their hemoglobin A1C is six or seven, I will take the time, and I think I have the time based on the study design to engage with primary care, to engage with endocrine if that's what I need to do in order to get that patient to a safe place before we start this medication. And as you said, if they do have a diagnosis of diabetes, they will have that home monitor.
And so, they can do that test on day three or four in week one. And they have to check in week two, week four, week six, and week eight. And then, monthly going forward. So if they already have the monitor, they can do that at home. But again, that good communication is going to be critical. So this is one that we do need to stay on top of and sometimes employ our colleagues to help us. And it's one that, I think, is important for us all in our practices to think about these strategies, get them laid out in the front end. And actually, think about talking to the company. AstraZeneca has educational materials that you can keep in your clinical space.
And we can also talk to our colleagues if you're in medical oncology who do breast cancer because they have strategies. Already, this is a drug that's used in the breast cancer space as well. So phoning a friend always an option. So as we think about this, we've got a lot that we're putting together. And I think it certainly is something that we can embark on as a team learning new things. The other piece of this is learning how to test for PTEN. So Zach, I wonder from your perspective as a urologist, how are you coordinating your team around testing for PTEN using this IHC technique, which is something a little bit different in prostate cancer care?
Zachary Klaassen: Yeah, I think you nailed it, Alicia. It's a team effort. It has been a team effort for a while now. And I think this is, as we've already alluded to, this is almost an obligation as part of our checklist to test for this. So whoever's already doing this, I think they're the ones that should be driving. If they're doing germline, if they're doing somatic, they should be the ones that are ordering it, whether it's a physician, whether it's an APP.
And really like anything, it's the follow-up and making sure that sort of... And you alluded to as well. It doesn't have to be started on that first day, but knowing that this is going to be part of a conversation in that follow-up visit. And really, having the opportunity again to have a biomarker specific targeted treatment in traditionally what's been a little bit earlier than we have in other treatments in mCRPC, for instance, in that mHSPC space to really provide that patient with the best opportunity to get the optimal results.
Alicia Morgans: Wonderful. So in our practice, at this point in time, I send a quick message over to our pathology specialists. I actually do this with other biomarkers that we need to test with IHC or special staining, things like DLL3 for small cell and others. Especially if they already have the slides in-house, they can turn around this stain usually very quickly within a matter of days or a day in some cases.
Zachary Klaassen: Yep.
Alicia Morgans: So that's really nice that it's not a prolonged send-out test. There are also send-out versions. So people can do this as a send-out. And there are laboratories that have been set up to do this for your practice. And so, that's something that's reliable too. I would say it's important when we're trying to... In the study, they were able to look at 100% PTEN loss and 99% PTEN loss, 95, and 90. And patients need to have 90% or more to be eligible for this treatment. My pathologist said, "Look, we can basically do greater than 90% loss, and we can tell you 100% loss."
But somewhere in the middle, especially because we're training a lot of people, there's a lot of people that are reading this, it's hard to standardize some of those middle grounds. That's in my practice. And I think that's okay. I just need to know 90% or more. It's just of my interest to communicate with patients. If they have 100% loss, I'm excited to share that, but that's not required for me to treat a patient. So if your pathologist says that too, I just want you to know as a community, this may be the case because these are very nuanced differences, and it may not be every laboratory that's going to be able to do it. And I don't know, Zach, what your thoughts are on that.
Zachary Klaassen: Yeah. No, I totally agree. I think the one thing I'll add too, Alicia, is if you have a GU-specific pathologist, you do, I do, a lot of people do, but there may be people, smaller community, they're running big oncology practice. Maybe they get pathology from all over the place. The nice thing is is that this is not a difficult test for the pathologist to do.
So it may take some more educating of that specific pathologist who may be looking at colon, prostate, breast, et cetera. I think it's in their wheelhouse. And it's just a matter of us telling them why we need it and the importance of it. And again, you mentioned too, it's a quick turnaround. We're not waiting weeks for this to come back.
Alicia Morgans: Great. Kara, in your practice, do you find that APPs like PAs or NPs can be integral parts of these testing processes? Is PTEN something that might be, in some practices, owned by a PA or a nurse practitioner?
Kara Cossis: Yes, absolutely. So a lot of our patients have touchpoints in what we have advanced prostate cancer clinics. And so, the majority of our patients do se APPs. And kind of talking through that, I guess that checkbox, they're trying to really gather all the pieces. Do they have updated imaging? Do they have updated labs? Have they had somatic or germline testing if appropriate? Are they advancing in their disease or that?
So basically, we're trying to have somebody who has frequent touchpoints and are checking all the boxes. So at least in our practice, and really in any practice, I think if they have APPs involved, it's definitely something that's doable, and hopefully something that would be easy enough to kind of integrate into their office visit to just assess the need and to be able to do the ordering.
Alicia Morgans: Great. Thank you. And Christina, I wonder, as you're thinking about starting a patient on this and you're thinking about that four days on, three days off regimen, this can be complicated, and of course that excellent communication. What are some things that APPs can take the lead in in terms of talking with patients before they're starting the therapy or as they're just getting started?
Christina Lee: I think more than just verbal counseling, I think it would be important to have actual physical patient handouts because it's a lot of information to absorb. It can also help them be more invested and accountable in a way for them to track physically because it is very complicated. There's a lot of things you want to watch out for, but if we can make little calendar sheets for them, and that way they can cross off in like checkbox. You know, check this, check this, check this just to bear off Kara. I think that would be very empowering for the patient. I found when patients can be more involved with their care, we always get better outcomes.
Alicia Morgans: Yeah, I could not agree more with that for sure. And Brenda, I wonder from your perspective, what do you think about in terms of that ongoing engagement? You had mentioned bringing patients in. And as a nurse practitioner, you may be able to bring them in more often than perhaps the physician colleague that's working with you. Is that something that you would integrate into your follow-up paradigm to look at their checkboxes, to check on their sugars, or to do anything else?
Brenda Martone: Oh, absolutely. I think, again, just the frequent follow-up consistency of care, making sure a set of eyes are on the patient. And again, just opening the door for them to reach out, I think, is extremely important. And just to kind of make a comment about the dosing and how to kind of tell patients, my pharmacist had a really good suggestion about starting people on a Monday.
So they would dose Monday through Thursday. And you could tell them they get three days off for the weekend. That was just something creative that I though was helpful. And also in addition to having calendars again, so they can check their boxes and know that they've taken something. So yeah, this is pretty exciting. I think this is going to be really great for prostate cancer patients with the PTEN loss.
Alicia Morgans: I love that you get a three-day weekend off memory trick. I think I will absolutely use that, and I think many people will. That's great. Tell the pharmacist, "Thank you." So I think at this point we'll wrap up. We've had a wonderful conversation about the practical ways that we can use this new therapy. Capivasertib in combination with abiraterone, an old standby, but a highly effective medicine for patients with metastatic hormone-sensitive prostate cancer.
Really, an exciting advance in this disease setting for patients with PTEN loss. And I would love to hear a takeaway from each of you. What is your message to those who are watching as they're starting in this new era of further personalizing therapy? Zach, why don't you go ahead?
Zachary Klaassen: I mean, we've added another layer, which is exciting. And I'm grateful for all the APPs out there that are helping us manage these patients because as we've gone through tonight, there is a lot going on. And it's important to have open lines of communication, time with the APPs to educate. And I think this is just such a multi-collaborative effort. So thank you.
Alicia Morgans: Thank you. Christina, go ahead.
Christina Lee: I would say there is hope, and we're here to support you every step along the way.
Alicia Morgans: I think patients appreciate that and need it now these days more than ever, I think. And Kara, what is your message?
Kara Cossis: I mean, I think that what we can see is that as we learn more and more about cancer, really, we're working to individualize treatments specific to the individual patients and their needs.
And this is just one more way to sort of see that. And I think patients just knowing that they may feel like they have a specific treatment that's unique to their personal cancer, it's really remarkable. And just more rah-rah for going for the testing, trying to check the boxes, and continuing to be part of something that's really amazing for these patients.
Alicia Morgans: Thank you, Kara. And Brenda, a practical tip from you. Go ahead, please.
Brenda Martone: I'd say since 2010, we basically had an explosion, in treatments obviously. And I think it's long overdue for our prostate cancer population. I'm really glad there's an investment to look at different ways that we can manage prostate cancer and target different pathways. And I think this also provides a lot of hope to our patients as well as those taking care of them. We all want patients to have success, have time with their families, be here with us as long as possible. So I'm thinking this is a great new addition to what we have available.
Alicia Morgans: Wonderful. Thank you. So I think we've learned PTEN testing is important. It needs to happen early on in that metastatic hormone-sensitive prostate cancer diagnosis. And for patients who have at least 90% PTEN loss by IHC, they can be eligible for capivasertib and abiraterone in combination. These patients have a longer time to progression and other endpoints are improved. And we do need to counsel patients on certain side effects in particular, hyperglycemia, rash, and diarrhea.
We can help them to be proactive, encourage that good communication, work as a multidisciplinary team, as NPs, PAs, and others, nurses, physicians, pharmacists to make sure that we are using proactive strategies. And we can also, of course, engage with the company to try to get materials that may be helpful in that management as well. But the multidisciplinary team is going to be the road to success here. And I thank all of you for your time today, and I look forward to talking with you again in the future. Thank you.
Kara Cossis: Thank you.
Zachary Klaassen: Thanks.