Con$nuing Care for Your Pa$ents with Metasta$c CRPC
|
|
- Clifford Lloyd
- 6 years ago
- Views:
Transcription
1 27 th Annual InternaAonal Prostate Cancer Symposium Update January 26, 2017 Con$nuing Care for Your Pa$ents with Metasta$c CRPC Michael S. Cookson, MD, MMHC Professor and Chair Department of Urology University of Oklahoma Health Science Center
2 Overview IntroducAon Urologists as the Primary Caregiver Establishing a MulAdisciplinary CRPC Clinic Evidenced Based TherapeuAc OpAons Conclusions
3 Lesson #1 The Urologist should be the primary caregiver for men with Prostate Cancer This includes paaents as they progress through the disease spectrum and especially those with CRPC
4 Urologist as the Primary Caregiver PaAents progress through disease spectrum, but should not have to progress through specialists! Role of the Urologist Diagnose and treat prostate cancer Understand the progression of the disease Understand the management of the progression Coordinate the care between specialists
5 Lesson #2 Establish, organize and manage a MulAdisciplinary CRPC Clinic that incorporates your available resources and works best for your clinical healthcare environment
6 MulAdisciplinary CRPC Clinic In response to the changing landscape, clinicians are altering care delivery to incorporate these treatments Even with guidelines, the breadth of treatment opaons allows for alternaave views on Aming and sequencing of agents One approach includes Shared Pa$ent Care in a MDC Reports from MDCs show high paaent saasfacaon rates, improved classificaaon of disease and clinical outcomes Studies of other tumors have also provided evidence that a MDC approach may impact paaent survival
7 Models for Establishing a MulAdisciplinary CRPC Clinic ALL- IN- ONE MDC
8 MulAdisciplinary CRPC Clinic CriAcal step is determining clinic structure Established clinics show an all- in- one approach may be most efficient, paracularly from paaent point of view Discuss treatment with specialists on the same day Decreases Ame and travel burden on paaents while improving communicaaon; potenaally increasing acceptance into clinical trials
9 MulAdisciplinary CRPC Clinic However, Ame and space limitaaons may prevent widespread use of the all- in- one model Furthermore the all- in- one clinic may reduce producavity and have financial disincenaves Obstacles to implemenang a MDC at a single locaaon can be managed by a virtual MDC
10 MulAdisciplinary CRPC Clinic Two alternaave approaches to the all- in- one MDC are the same day/different clinic and the different day/ different clinic models For providers with clinic locaaons in proximity, paaents can be evaluated on the same day between the clinics Care may then be coordinated through group meeang, tumor boards or messaging among providers
11 Models for Establishing a MulA- Disciplinary CRPC Clinic Virtual MDC Models 1. Same day/different clinic 2. Different day/different clinic
12 MDC CRPC: Key Ingredients PaAent Navigator Physician Assistants and/or Nurse PracAAoners Weekly meeangs w/ MulAD specialist: Tumor Boards Shared EMR (if possible) PCP to manage comorbid condiaons SupporAve care, nutriaonists, and pain management
13 Lesson #3 Offer Evidence Based TherapeuAc OpAons for paaents with metastaac CRPC GUIDELINES (AUA, NCCN, EAU)
14
15
16 mcrpc Changing Landscape Surgery / Radiation Asymptomatic/Minimally symptomatic Traditional Androgen Deprivation Therapy Symptomatic Local Therapy Androgen Deprivation Antiandrogen AAW Therapies After LHRH Agonists and Antiandrogens Chemotherapy Radium-223 Abiraterone or Enzalutamide Postchemotherapy Death Sipuleucel-T Docetaxel Cabazitaxel Radiation Therapy Prostate Cancer. NCCN Guidelines. v3.2016, AUA CRPC Guidelines, 2016.
17 CLINICAL GUIDANCE Since the approval of docetaxel in 2004, the first drug to offer survival benefits for CRPC paaents, five addiaonal agents have demonstrated a survival benefit and have now been approved on the basis of randomized clinical trials. Abiraterone Cabazitaxel Enzalutamide Radium 223 Sipuleucel- T
18 TREATMENT EVOLUTION 2004: Docetaxel Tannock et al. (TAX 327) 2010: Cabazitaxel de Bono et al. (TROPIC) 2012: Enzalutamide Scher et al. (AFFIRM) 2013: Radium 223 Parker et al. (ALSYMPCA) While the greater availability of treatment agents benefits paaents, the mulaple opaons and sequencing of medicaaons complicates clinical decision- making. 2010: Sipuleucel- T Kantoff et al. (IMPACT) 2011: Abiraterone de Bono et al. (COU- AA- 301) 2013: Abiraterone Ryan et al. (COU- AA- 302) 2014: Enzalutamide Beer et al. (PREVAIL)
19 INDEX PATIENTS To assist in clinical decision- making, six index pa$ents were developed represen$ng the most common clinical scenarios that are encountered in clinical prac$ce These index pa$ents were created based on the following: 1. Presence or absence of metasta$c disease 2. Degree and severity of symptoms 3. Pa$ents performance status (ECOG scale) 4. Prior docetaxel chemotherapy
20 INDEX PATIENTS 1. Asymptoma$c non- metasta$c CRPC 2. Asymptoma$c or minimally- symptoma$c, mcrpc without prior docetaxel 3. Symptoma$c, mcrpc with good performance status and no prior docetaxel 4. Symptoma$c, mcrpc with poor performance status and no prior docetaxel 5. Symptoma$c, mcrpc with good performance status and prior docetaxel 6. Symptoma$c, mcrpc with poor performance status and prior docetaxel
21 INDEX PATIENT 1 Asymptoma$c non- metasta$c CRPC (M0) Clinicians should recommend observa2on with con2nued androgen depriva2on to pa2ents with non- metasta2c CRPC. (Recommenda*on; Evidence Level Grade C) Clinicians may offer treatment with first- genera2on an2- androgens (flutamide, bicalutamide and nilutamide) or first- genera2on androgen synthesis inhibitors (ketoconazole+steroid) to select pa2ents who are unwilling to accept observa2on. (Op*on; Evidence Level Grade C) Clinicians should NOT offer systemic chemotherapy or immunotherapy to pa*ents with outside the context of a clinical trial. (Recommenda*on; Evidence Level Grade C)
22 INDEX PATIENT 2 Asymptoma$c or minimally symptoma$c, metasta$c mcrpc (M1) without prior docetaxel chemotherapy Clinicians should offer abiraterone + prednisone, enzalutamide, docetaxel or sipuleucel- T to pa*ents with good performance status. [Standard; Evidence Level Grade A (abiraterone+prednisone and enzalutamide) / B (docetaxel and sipuleucel- T)] Clinicians may offer first- genera*on an*- androgen therapy, ketoconazole + steroid or observa*on who do not want or cannot have one of the standard therapies. (Op*on; Evidence Level Grade C)
23 ABIRATERONE: COU- 302 COU- AA- 302: 1,088 men with mcrpc who had not received prior chemotherapy Prednisone 5mg twice daily plus 1,000mg abiraterone daily OR placebo ParAcipants receiving abiraterone had staasacally significantly bemer radiographic progression- free and overall survival (HR = 0.53, p<0.001 and HR= 0.75, p= 0.01, respecavely) Ryan et al. NEJM 2013
24 ABIRATERONE: COU- 302 Ryan et al. Lancet Oncology 2015
25 ENZALUTAMIDE: PREVAIL The Phase III PREVAIL trial evalua$ng enzalutamide versus placebo in 1,717 chemotherapy- naive men with asymptoma$c or mildly symptoma$c mcrpc (including some with visceral metastases) was stopped a`er a planned interim analysis conducted when 540 deaths had been reported Enzalutamide (160mg/day) Placebo Overall survival HR 0.706, 95% CI [ ] P<0.001 Radiographic progression- free survival HR 0.186, 95% CI [ ] Beer T, et al. NEJM 2014
26 ENZALUTAMIDE: PREVAIL Pa$ent Popula$on: 1717 men with progressive mcrpc Asymptoma$c/ mildly symptoma$c Chemotherapy- naïve Steroids allowed but not required Prior an$androgens allowed but not required Pa$ents with visceral disease (liver and/or lung) allowed R A N D O M I Z E D 1:1 Enzaluta mide 160 mg/day n = 872 (ADT was maintained) Placebo n = 845 (ADT was maintained) Coprimary Endpoint s: rpfs Overall survival ADT=androgen deprivaaon therapy. Beer T, et al. NEJM 2014
27 ENZALUTAMIDE: OVERALL SURVIVAL ENZALUTAMIDE: PREVAIL PREVAIL: Co- Primary Endpoints PFS 81% decreased risk of progression or death OS 29% decreased risk of death Armstrong AJ. ASCO 2014, abstract *Median OS follow-up: ~22 months
28 DOCETAXEL: TAX- 327 TAX- 327 included 1,006 men with mcrpc and good performance status 5 mg prednisone twice daily plus docetaxel 75mg every three weeks OR docetaxel 30mg weekly for five of every six weeks OR mitoxantrone 12mg every three weeks PaAents who received docetaxel every three weeks showed significantly bemer survival than those receiving mitoxantrone (HR= 0.76, p= 0.009). Tannock et al. NEJM 2004
29 TAX- 327 OVERALL SURVIVAL Docetaxel q3w Docetaxel q1w Mitoxantrone Propor$on alive Median OS Hazard ratio P value Doc q3w Doc weekly Mitoxantrone Time (years) Berthold DR et al. J Clin Oncol 2008;26:
30 SIPULEUCEL- T: IMPACT The IMPACT trial included 512 men with asymptoma$c or minimally symptoma$c mcrpc and good func$onal status PaAents received either sipuleucel- T or placebo on a 2:1 basis. Compared to placebo, sipuleucel- T was associated with a relaave reducaon of 22% in the risk of death (HR= 0.78, p= 0.03). Some have criacized the IMPACT trial, noang that it failed to show an advantage for acave agent in the trial s second endpoint (progression- free survival). Kantoff et al. NEJM 2010
31 SIPULEUCEL- T: IMPACT Median Survival: Sipuleucel- T (n=341) 25.8 Mos. HR = (95% CI: 0.614, 0.979) Survival Benefit = 4.1 months P = (Cox Model) Placebo (n=171) 21.7 Mos. Kantoff et al. NEJM 2010
32 INDEX PATIENT 3 Symptoma$c, mcrpc with good performance status and no prior docetaxel chemotherapy Clinicians should offer abiraterone + prednisone, enzalutamide or docetaxel to pa*ents with symptoma*c, mcrpc with good performance status and no prior docetaxel chemotherapy. [Standard; Evidence Level Grade A (abiraterone + prednisone and enzalutamid/ B (docetaxel)] Clinicians may offer ketoconazole + steroid, mitoxantrone or radionuclide therapy to pa*ents who do not want or cannot have one of the standard therapies. [Op*on; Evidence Level Grade C (ketoconazole) /B (mitoxantrone) / C (radionuclide therapy)]
33 INDEX PATIENT 3 Symptoma$c, mcrpc with good performance status and no prior docetaxel chemotherapy Clinicians should offer radium- 223 to pa2ents with symptoms from bony metastases from mcrpc with good performance status and no prior docetaxel chemotherapy and without known visceral disease. (Standard; Evidence Level Grade B) Clinicians should NOT offer treatment with either estramus*ne or sipuleucel- T to pa*ents with symptoma*c, mcrpc (Recommenda*on; Evidence Level Grade C)
34 RADIUM- 223 PaAents 1,2 StraAficaAon 2 Treatment 1,2 N=921 Prior docetaxel: Radium Ra223 Yes vs No dichloride (50 kbq/ CRPC with Current kg) + best standard 6 injec$ons at symptomaac bisphosphonate of care 4- week (n=614) intervals bone metastases use: Yes vs No Placebo (saline) + No known Total alkaline best standard of 136 centers in 19 countries visceral phosphatase care (n=307) metastases Included paaents with malignant (ALP): <220 lymphadenopathy U/L up to 3cm 1 Best standard of care included: vs >220 U/L local external beam radiaaon therapy (EBRT), coracosteroids, anaandrogens, estrogens, 1. Radium estramusane, RA 223 dichloride injecaon; or ketoconazole 2. Parker C, al. N 1 Engl J Med. 2013;369:
35 RADIUM- 223 radium Ra 223 dichloride* Radium Ra 223 dichloride median OS: 14.9 months (95% Cl: ) Placebo* Placebo median OS: 11.3 months (95% Cl: ) radium Ra dichloride placebo % reducaon in the risk of death vs placebo (HR=0.695) *Plus best standard of care; *95% Cl: for the exploratory updated analysis.
36 INDEX PATIENT 5 Symptoma$c, mcrpc with good performance status and prior docetaxel chemotherapy Clinicians should offer treatment with abiraterone + prednisone, cabazitaxel or enzalutamide. If the pa*ent received abiraterone + prednisone or enzalutamide prior to docetaxel chemotherapy, he should be offered cabazitaxel. [Standard; Evidence Level Grade A (abiraterone) /B (cabazitaxel) /A (enzalutamide)]
37 CABAZITAXEL An open- label, randomized Phase III trial included 755 pa$ents who had received prior docetaxel 25mg cabazitaxel intravenously with oral prednisone every three weeks 12mg mitoxantrone intravenously with oral prednisone every three weeks Cabazitaxel demonstrated improved overall survival (15.1 months v months) and improved progression- free survival (2.8 months v. 1.4 months). de Bono et al. Lancet 2010
38 CABAZITAXEL HR = 0.70 (95% CI: 0.59, 0.83) P < % reduc$on in rela$ve risk of death Cabazitaxel Median Survival: 15.1 Mos. Mitoxantrone Median Survival: 12.7 Mos. de Bono et al. Lancet 2010
39 Post Chemotherapy Clinical Trials Trial/ Agent/ Date Approved Mechanism Comparator Survival (months) Hazard Ratio P-value Reference AFFIRM Enzalutamide Androgen Receptor Signaling Inhibitor Placebo 18.4 vs < de Bono et al, ASCO 2012 COU-AA-301 Abiraterone + prednisone 2011 CYP17 Inhibitor Placebo + prednisone 14.8 vs < de Bono et al, NEJM 2011 TROPIC Cabazitaxel + prednisone 2010 Cytotoxic Mitoxantrone + prednisone 15.1 vs < de Bono et al, Lancet 2010 Radium 223* Alpha-particle emitting radionuclide Placebo 14.9 vs Parker et al, ESMO 2011 *Radium-223 trial included chemotherapy-ineligible men Visceral disease allowed
40 Future DirecAons: M0 CRPC Many clinical trials currently underway
41 M0 CRPC - PROSPER: Enzalutumide Recrui$ng N = 1560 Patients with nonmetastatic CRPC No prior chemotherapy R 2:1 Enzalutamide 160 mg qd + ADT n = 1040 Placebo+ ADT n = 520 P3, multinational, randomized, placebocontrolled study Primary endpoint: Metastasis-free survival* * Defined as the *me from randomiza*on to radiographic progression or death on study CRPC = castra*on- resistant prostate cancer; EQ- 5D- 5L = European quality of life- 5 dimensions- 5 levels; FACT- P = func*onal assessment of cancer therapy- prostate; PSA = prostate- specific an*gen; QLQ- PR25 = quality of life ques*onnaire- prostate 25; R = randomized Planned Evaluations Metastasis-free survival Overall survival Time to pain progression Time to opiate use for prostate cancer pain Time to first use of cytotoxic chemotherapy Time to first use of new antineoplastic therapy PSA response rates Time to PSA progression Time to functional status deterioration as assessed by the FACT-P global score Quality of life as assessed by the EQ-5D-5L health questionnaire and QLQ-PR25 module Safety (NCT )
42 N=1200 M0 CRPC; ECOG 0 or 1 M0 CRPC - SPARTAN: ARN- 509 Recruiting No prior treatment with second generaaon hormonal agents, radiopharmaceuacal agents, chemotherapy, or other invesagaaonal agents, or history of or predisposiaon to seizure R 2:1 ARN mg/d + ADT Placebo + ADT Primary Endpoint Metastasis Free Survival (MFS) Key Secondary Endpoints Overall Survival (OS) Time to symptomaac radiographic progression Time to iniaaaon of cytotoxic chemotherapy Radiographic Progression Free Survival (rpfs) Time to metastasis QOL: change in FACT- P and EQ- 5D quesaonnaire scores Adverse events (MedDRA) PharmacokineAcs (NCT )
43 M0 CRPC - ARAMIS: ODM-201 Recruiting N=1500 M0 CRPC, prostate- specific anagen doubling Ame of 10 months and PSA > 2 ng/ml, ECOG 0-1 No prior treatment with: second generaaon androgen receptor inhibitors, other invesagaaonal AR inhibitors, or CYP17 enzyme inhibitor or prior chemotherapy or immunotherapy R 2:1 ODM mg bid + ADT Placebo + ADT Primary Endpoint Metastasis- Free Survival Key Secondary Endpoints OS Time to first symptomaac skeletal event Time to iniaaaon of chemotherapy Time to pain progression (NCT )
44 SPECTRUM OF DISEASE
45 Conclusions Urologists should be the Primary Caregiver for men with Advanced Prostate Cancer Establishing a MulAdisciplinary CRPC Clinic is an essenaal component to care delivery Evidenced Based TherapeuAc OpAons exist, and familiarity and use will enhance outcome
Index Patients 3& 4. Guideline Statements 10/11/2014. Enzalutamide Reduced the Risk of Death
//4 Prolonged Radiographic Progression-Free Survival Reduced the Risk of Death Overall ITT Population Estimated median rpfs, months (9% CI): : NYR (.8 NYR); placebo:.9 (.7.4) rpfs (%) ( Enza 9 8 7 4 8
More informationUntil 2004, CRPC was consistently a rapidly lethal disease.
Until 2004, CRPC was consistently a rapidly lethal disease. the entry in systemic disease is declared on a an isolated PSA recurrence after local treatment so!!! The management of CRPC and MCRPC is different
More informationManagement of castrate resistant disease: after first line hormone therapy fails
Management of castrate resistant disease: after first line hormone therapy fails Rob Jones Consultant in Medical Oncology Beatson Cancer Centre Glasgow Relevant Disclosure I have received research support
More informationPLAATS VAN DE CHEMOTHERAPIE IN DE BEHANDELING VAN EEN PROSTAATCARCINOOM: EEN UPDATE. Daan De Maeseneer, Medisch Oncoloog
PLAATS VAN DE CHEMOTHERAPIE IN DE BEHANDELING VAN EEN PROSTAATCARCINOOM: EEN UPDATE Daan De Maeseneer, Medisch Oncoloog 1 Overview DEAT PSA/Tumor Burden METASTASES INITIAL DIAGNOSIS & THERAPY ADT CRP SREs/
More informationSESSIONE PLATINUM SERIES (Best Papers Poster o Abstract on Prostate Cancer) In Oncologia
SESSIONE PLATINUM SERIES (Best Papers Poster o Abstract on Prostate Cancer) In Oncologia Divisione di Oncologia Medica Unità Tumori Genitourinari SESSIONE PLATINUM SERIES (Best Papers Poster o Abstract
More informationSequencing Strategies in Metastatic Castration Resistant Prostate Cancer (MCRPC)
Sequencing Strategies in Metastatic Castration Resistant Prostate Cancer (MCRPC) Amit Bahl Consultant Oncologist Bristol Cancer Institute Clinical Director Spire Specialist Care Centre UK Disclosures Advisory
More informationManagement of mcrpc: Hormonal therapy and treatment sequence for CRPC
Management of mcrpc: Hormonal therapy and treatment sequence for CRPC Professor Bertrand Tombal, MD, PhD Cliniques universitaires Saint-Luc Université catholique de Louvain Brussels, Belgium Credentials
More informationNovel treatment for castration-resistant prostate cancer
Novel treatment for castration-resistant prostate cancer Cora N. Sternberg, MD, FACP Chair, Department of Medical Oncology San Camillo and Forlanini Hospitals Rome, Italy Treatment options for patients
More informationManagement of castration resistant prostate cancer after first line hormonal therapy fails
Management of castration resistant prostate cancer after first line hormonal therapy fails Simon Crabb Senior Lecturer in Medical Oncology University of Southampton WHAT ARE THE AIMS OF TREATMENT? Cure?
More informationAdvanced Prostate Cancer
Advanced Prostate Cancer SAMO Masterclass 4 th March 2016 Aurelius Omlin Conflicts of interest Advisory Rolle: Astra Zeneca, Astellas, Bayer, Janssen, Pfizer, Sanofi Aventis Research support: TEVA, Janssen
More information2014 Treatment Paradigms in mcrpc Docetaxel in hormone sensitive PC
Ronald de Wit Erasmus MC Cancer Institute The Netherlands 2014 Treatment Paradigms in mcrpc Docetaxel in hormone sensitive PC Disclosures Sanofi ; research grant support, consultancy and speaker fees Astellas;
More informationSecond line hormone therapies. Dr Lisa Pickering Consultant Medical Oncologist ESMO Preceptorship Singapore 2017
Second line hormone therapies Dr Lisa Pickering Consultant Medical Oncologist ESMO Preceptorship Singapore 2017 Disclosures Institutional Research Support/P.I. Employee Consultant Major Stockholder Speakers
More informationHormonal Manipulations in CRPC. NW Clarke Professor of Urological Oncology Manchester UK
Hormonal Manipulations in CRPC NW Clarke Professor of Urological Oncology Manchester UK Standard Treatment of CRPC Pre 2004 (and in 2013?) PSA progression 99m Tc BS negative CT scan large lymph node component
More information- La Terapia Farmacologica -
XXV Congresso Nazionale AIRO Simposio AIRO-AIMN: Trattamento delle Metastasi Ossee nel Paziente con Tumore della Prostata "Ormonorefrattario": - La Terapia Farmacologica - Sergio Bracarda, Medical Oncology
More informationWhen exogenous testosterone therapy is. adverse responses can be induced.
Theoretical tips It has been reasoned that discontinuation of ADT in nonorchiectomized patients may have detrimental effect on patients with CRPC as discontinuation of ADT can result in renewed release
More informationSession 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy
Session 4 Chemotherapy for castration refractory prostate cancer First and second- line chemotherapy October- 2015 ESMO 2004 October- 2015 Fyraftensmøde 2 2010 October- 2015 Fyraftensmøde 3 SWOG 9916 OS
More informationSYSTEMIC THERAPIES FOR CRPC: Chemotherapy and Radium-223
SYSTEMIC THERAPIES FOR CRPC: Chemotherapy and Radium-223 ELENA CASTRO Spanish National Cancer Research Centre Prostate Preceptorship. Lugano 4-5 October 2018 Disclosures Participation in advisory boards:
More informationGroup Sequential Design: Uses and Abuses
Group Sequential Design: Uses and Abuses Susan Halabi Department of Biostatistics and Bioinformatics, Duke University October 23, 2015 susan.halabi@duke.edu What Does Interim Data Say? 2 Group Sequential
More informationManagement of Incurable Prostate Cancer in 2014
Management of Incurable Prostate Cancer in 2014 Julie N. Graff, MD, MCR Portland VA Medical Center Assistant Professor of Medicine Knight Cancer Institute, OHSU 2014: Cancer Estimates Stage at Diagnosis
More informationManagement of castrate resistant disease; after first line hormone therapy fails
Management of castrate resistant disease; after first line hormone therapy fails Dr. Syed A Hussain Clinical Senior Lecturer and Consultant in Medical Oncology University of Liverpool and Clatterbridge
More informationJoelle Hamilton, M.D.
Joelle Hamilton, M.D. www.urologycentersalabama.com Case Presentation: CRPC, Rising PSA 70 yo healthy, fit, active man post RALP 8 years prior with rising PSA Rising PSA from 0.02 nadir to 3.4 thus ADT
More informationSecondary Hormonal therapies in mcrpc
Secondary Hormonal therapies in mcrpc Ravindran Kanesvaran Consultant,Division of Medical Oncology National Cancer Centre Singapore 1 Disclosures Research Support/P.I. Sanofi Consultant Major Stockholder
More informationProstate Cancer 2009 MDV Anti-Angiogenesis. Anti-androgen Radiotherapy Surgery Androgen Deprivation Therapy. Docetaxel/Epothilone
Prostate Cancer 2009 Anti-Angiogenesis MDV 3100 Anti-androgen Radiotherapy Surgery Androgen Deprivation Therapy Docetaxel/Epothilone Abiraterone DC therapy Bisphosphonates Denosumab Secondary Hormonal
More informationStrategic decisions for systemic treatment. metastatic castration resistant prostate cancer (mcrpc)
Strategic decisions for systemic treatment metastatic castration resistant prostate cancer (mcrpc) SAMO Luzern 14.09.2012 Richard Cathomas Onkologie Kantonsspital Graubünden richard.cathomas@ksgr.ch mcrpc
More informationAdvanced Prostate Cancer. November Jose W. Avitia, M.D
Advanced Prostate Cancer November 4 2017 Jose W. Avitia, M.D In 2017 161,000 new cases of prostate cancer diagnosed in US, mostly with elevated PSA 5-10% will present with metastatic disease In 2017: 26,000
More informationMetasta&c prostate cancer. Walid Obeid PGY IV SGHUMC
Metasta&c prostate cancer Walid Obeid PGY IV SGHUMC Defini&on Stage IV prostate cancer : is defined by the American Joint CommiEee on Cancer's TNM classifica&on system: T4, N0, M0, any prostate- specific
More informationAmerican Urological Association (AUA) Guideline
1 Approved by the AUA Board of Directors April 2014 Authors disclosure of potential conflicts of interest and author/staff contributions appear at the end of the article. 2014 by the American Urological
More informationAdvanced Prostate Cancer. Searching for Optimal Therapy Sequence and Assessing Emerging Treatment Options
Advanced Prostate Cancer Searching for Optimal Therapy Sequence and Assessing Emerging Treatment Options Disclaimer This slide deck in its original and unaltered format is for educational purposes and
More informationAmerican Urological Association (AUA) Guideline
1 Approved by the AUA Board of Directors May 2018 Authors disclosure of potential conflicts of interest and author/staff contributions appear at the end of the article. 2018 by the American Urological
More informationRoberto Sabbatini Azienda Ospedaliero Universitaria Policlinico di Modena
Il Trattamento della Malattia CRPC metastatica Terapie Radiometaboliche Roberto Sabbatini Azienda Ospedaliero Universitaria Policlinico di Modena AIOM: Gestione ottimale del Paziente con Carcinoma della
More information8/31/ ) Intermittent androgen deprivation in androgen-sensitive PCa. 1) Alpharadin (Ra223) in CRPC with bone metastases
Bruce J. Roth, M.D. Clinical Trials: Medivation, Oncogenix 1) Alpharadin (Ra223) in CRPC with bone metastases 2) Enzalutamide (MDV-31) in CRPC and prior docetaxel 3) Abiraterone in chemo-naïve CRPC 4)
More informationSUMMARY. 3. Emerging understanding of mechanisms of resistance to current treatments
SUMMARY 1. Discuss the active agents in prostate cancer currently available in Australia 2. Celebrate the growing role for Prostate Medical Oncologists in Multi Disc Teams active treaments overall survival
More informationMÉTASTASES OSSEUSES ET RADIUM 223
MÉTASTASES OSSEUSES ET RADIUM 223 Marie-Laure Amram Service d oncologie Hôpitaux Universitaires de Genève Forome du 21.05.2015 Radium-22:3:mécanisme d action Mécanisme d action Mécanisme d action Radium-223
More informationPhilip Kantoff, MD Dana-Farber Cancer Institute
CHEMOTHERAPY FOR MCRPC Philip Kantoff, MD Dana-Farber Cancer Institute Harvard Medical School 1 Disclosure of Financial Relationships With Any Commercial Interest Name Nature of Financial Commercial Interests
More informationEvolution or revolution in the treatment of prostate cancer
Evolution or revolution in the treatment of prostate cancer de Johann Sebastian de Bono, MB, ChB, FRCP, MSc, PhD Professor of Experimental Cancer Medicine Department of Medicine/ Drug Development Unit
More informationGU Guidelines Update Meeting: M0 Castrate Resistant Prostate Cancer. Dr. Simon Yu Nov 18, 2017
GU Guidelines Update Meeting: M0 Castrate Resistant Prostate Cancer Dr. Simon Yu Nov 18, 2017 Faculty/Presenter Disclosure Faculty: Dr. Simon Yu Relationships with commercial interests: Grants/Research
More informationAdvanced Prostate Cancer
Advanced Prostate Cancer January 13, 2017 Sindu Kanjeekal MD FRCPC Medical Oncology and Hematology Regional Systemic Quality Lead Erie St Clair Adjunct Professor Schulich School of Medicine and University
More informationUpdates in Prostate Cancer Treatment 2018
Updates in Prostate Cancer Treatment 2018 Mountain States Cancer Conference Elaine T. Lam, MD November 3, 2018 Learning Objectives Understand the difference between hormone sensitive and castration resistant
More informationHave we optimized the use of Androgen Receptor pathway targeted drugs in Castrate-Resistant Prostate Cancer?
Have we optimized the use of Androgen Receptor pathway targeted drugs in Castrate-Resistant Prostate Cancer? Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France Disclosure Participation to
More informationNavigating Prostate Cancer Therapy. Nevin Murray MD Clinical Professor of Medicine, UBC Medical Oncologist, BCCA
Navigating Prostate Cancer Therapy Nevin Murray MD Clinical Professor of Medicine, UBC Medical Oncologist, BCCA Disclosures In compliance with accreditation, we require the following disclosures to the
More informationMichiel H.F. Poorthuis*, Robin W.M. Vernooij*, R. Jeroen A. van Moorselaar and Theo M. de Reijke
First-line non-cytotoxic therapy in chemotherapynaive patients with metastatic castration-resistant prostate cancer: a systematic review of 10 randomised clinical trials Michiel H.F. Poorthuis*, Robin
More informationNew Treatment Options for Prostate Cancer
New Treatment Options for Prostate Cancer Moderator: Jeremy P. Goldberg, President, JPG Healthcare LLC Panelists: Philip Kantoff, MD, Director, Lank Center for Genitourinary Oncology, Dana- Farber Cancer
More informationPerspective on endocrine and chemotherapy agents. Cora N. Sternberg Department of Medical Oncology San Camillo & Forlanini Hospitals Rome, Italy
Perspective on endocrine and chemotherapy agents Cora N. Sternberg Department of Medical Oncology San Camillo & Forlanini Hospitals Rome, Italy Disclosures Dr. Sternberg has received research funding for
More informationNAVIGATING THE mcrpc LANDSCAPE: EXPLORING KEY CLINICAL DECISION POINTS
NAVIGATING THE mcrpc LANDSCAPE: EXPLORING KEY CLINICAL DECISION POINTS Summary of presentations from the Bayer-supported satellite symposium, held at the European Association of Urology (EAU) Congress,
More informationINTERGRATING NON- HORMONAL THERAPIES INTO PROSTATE CANCER
INTERGRATING NON- HORMONAL THERAPIES INTO PROSTATE CANCER Daniel George, MD Professor of Medicine and Surgery Director of Genitourinary Oncology Program Duke Cancer Institute 1 Disclosures Consultant:
More informationWhat will change for men with advanced prostate cancer in the next 24 months? ESO Observatory: Perspective on endocrine and chemotherapy agents
Perspective on endocrine and chemotherapy agents Cora N. Sternberg Department of Medical Oncology San Camillo & Forlanini Hospitals Rome, Italy Disclosures Dr.Sternberg has received research funding for
More informationPublished on The YODA Project (
Principal Investigator First Name: David Last Name: Lorente Degree: MD Primary Affiliation: Medical Oncology Service, Hospital Provincial de Castellón E-mail: lorente.davest@gmail.com Phone number: +34
More informationAndrogens and prostate cancer: insights from abiraterone acetate and other novel agents
Androgens and prostate cancer: insights from abiraterone acetate and other novel agents Ian Davis Ludwig Institute for Cancer Research Austin Health, Melbourne, Australia Supported in part by an Australian
More informationASCO 2012 Genitourinary tumors
ASCO 2012 Genitourinary tumors Post ASCO Bern 14-06-2012 Dr. med. Richard Cathomas leitender Arzt Onkologie, KSGR, Chur Renal cell cancer Changes in first line treatment? Prostate cancer 3 positive phase
More informationWhen exogenous testosterone therapy is. adverse responses can be induced.
Theoretical tips It has been reasoned that discontinuation of ADT in non orchiectomized patients may have detrimental effect on patients with CRPC as discontinuation of ADT can result in renewed release
More informationChallenging Cases. With Q&A Panel
Challenging Cases With Q&A Panel Case Studies Index Patient #1 Jeffrey Wieder, MD Case # 1 72 year old healthy male with mild HTN Early 2011: Preop bone scan and pelvic CT = no mets Radical prostatectomy
More informationEarly Chemotherapy for Metastatic Prostate Cancer
Early Chemotherapy for Metastatic Prostate Cancer Daniel P. Petrylak, MD Professor of Medicine and Urology Smilow Cancer Center Yale University Medical Center Disclosure Consultant: Sanofi Aventis, Celgene,
More informationLONDON CANCER NEW DRUGS GROUP RAPID REVIEW
LONDON CANCER NEW DRUGS GROUP RAPID REVIEW Abiraterone for the treatment of metastatic castration-resistant prostate cancer that has progressed on or after a docetaxel-based chemotherapy regimen Disease
More informationMETASTATIC PROSTATE CANCER MANAGEMENT K I R U B E L T E F E R A M. D. T R I H E A LT H C A N C E R I N S T I T U T E 0 1 / 3 1 /
METASTATIC PROSTATE CANCER MANAGEMENT K I R U B E L T E F E R A M. D. T R I H E A LT H C A N C E R I N S T I T U T E 0 1 / 3 1 / 2 0 1 8 Prostate Cancer- Statistics Most common cancer in men after a skin
More informationIncorporating New Agents into the Treatment Paradigm for Prostate Cancer
Incorporating New Agents into the Treatment Paradigm for Prostate Cancer Dr. Celestia S. Higano FACP, Professor, Medicine and Urology, Uni. of Washington Member, Fred Hutchinson Cancer Research Center
More informationOptimizing Outcomes in Advanced Prostate Cancer
Optimizing Outcomes in Advanced Prostate Cancer Module 3: Focus on Recent CRPC Guidelines and Advanced Hormone-Sensitive Disease Sébastien J. Hotte, MD, MSc (HRM), FRCPC Medical Oncologist and Head, Phase
More informationProstate cancer update: Dr Robert Huddart Cancer Clinic London
Prostate cancer update: 2013 Dr Robert Huddart Cancer Clinic London Recent developments Improved imaging New radiotherapy technologies Radiotherapy for advanced disease Intermittent hormone therapy New
More informationwww.drpaulmainwaring.com Figure 1 Androgen action Harris W P et al. (2009) Nat Clin Pract Urol doi:10.1038/ncpuro1296 Figure 2 Mechanisms of castration resistance in prostate cancer Harris W P et al. (2009)
More informationPatients Living Longer: The Promise of Newer Therapies
Patients Living Longer: The Promise of Newer Therapies David M. Nanus, MD! Chief, Division of Hematology and Medical Oncology! Weill Cornell Medicine! New York Presbyterian Hospital!! Demographics 180,890
More informationSOGUG meeting New drugs after docetaxel chemotherapy in patient with mcrpc
SOGUG meeting New drugs after docetaxel chemotherapy in patient with mcrpc Stéphane OUDARD, MD, PhD Head of the Oncology department Georges Pompidou Hospital, Paris France University Rene Descartes, Paris
More informationProstate Cancer Management: From Early Chemical Recurrence to HRPC (excluding Immunotherapy).
Thanks to: The Medical Educator Consortium Luis Raez, MD, Florida International University 15th ed. Prostate Cancer Management: From Early Chemical Recurrence to HRPC (excluding Immunotherapy). Mayer Fishman,
More informationManagement of Prostate Cancer
Management of Prostate Cancer An ESMO Perspective Alan Horwich Conflicts of Interest Disclosure Alan Horwich I have no personal conflicts of interest relating to prostate cancer. European Incidence and
More informationLower Baseline PSA Predicts Greater Benefit From Sipuleucel-T
Lower Baseline PSA Predicts Greater Benefit From Sipuleucel-T Schelhammer PF, Chodak G, Whitmore JB, Sims R, Frohlich MW, Kantoff PW. Lower baseline prostate-specific antigen is associated with a greater
More informationmcrpc in 2016 How to decide the optimal treatment? N. Mottet
mcrpc in 2016 How to decide the optimal treatment? N. Mottet Disclosures Conflict of interest Chairman EAU PCa guidelines..... Therefore I'm 100% biased Castrate-resistant prostate cancer (CRPC) Definition
More informationManagement of castrate resistant disease: after first line hormone therapy fails
Management of castrate resistant disease: after first line hormone therapy fails Rob Jones Consultant in Medical Oncology Beatson Cancer Centre Glasgow Rhona McMenemin Consultant in Clinical Oncology The
More informationAdvanced Prostate Cancer. SAMO Masterclass 17 th of March 2017 PD Dr. med. Aurelius Omlin
Advanced Prostate Cancer SAMO Masterclass 17 th of March 2017 PD Dr. med. Aurelius Omlin aurelius.omlin@kssg.ch Conflicts of Interest Research Support: TEVA, Janssen Advisory Rolle: Astra Zeneca, Astellas,
More informationCancer de la prostate métastatique: prise en charge précoce
Cancer de la prostate métastatique: prise en charge précoce Stéphane Oudard, MD, PhD Georges Pompidou Hospital, Oncology Department, Paris, France stephane.oudard@egp.aphp.fr SAGB.CAB.14.08.0382c 3/02/2016
More informationBoard Review 2017: Prostate Cancer. Dana Rathkopf, MD Associate Attending
Board Review 2017: Prostate Cancer Dana Rathkopf, MD Associate Attending www.mskcc.org The Paradox of Prostate Cancer High prevalence in the general population: over diagnosis of clinically insignificant
More informationChemohormonal Therapy For Prostate Cancer. What is old, is new again!
Chemohormonal Therapy For Prostate Cancer What is old, is new again! Mount Tremblant January 20, 2017 Kala S. Sridhar MD, MSc, FRCPC Medical Oncologist, Princess Margaret Hospital Head, GU Medical Oncology
More informationPROSTATE CANCER HORMONE THERAPY AND BEYOND. Przemyslaw Twardowski MD Professor of Oncology Department of Urologic Oncology John Wayne Cancer Institute
PROSTATE CANCER HORMONE THERAPY AND BEYOND Przemyslaw Twardowski MD Professor of Oncology Department of Urologic Oncology John Wayne Cancer Institute Disclosures I am a Consultant for Bayer and Sanofi-Aventis
More informationSequencing treatment for metastatic prostate cancer
11 Sequencing treatment for metastatic prostate cancer SOPHIE MERRICK, STYLIANI GERMANOU, ROGER KIRBY AND SIMON CHOWDHURY In the past 10 years there have been significant advances in the understanding
More informationNCCN Guidelines for Prostate Cancer V Web teleconference 06/17/16 and 06/30/17
Guideline Page and Request PROS-1 Submission from Myriad Genetic Laboratories, Inc. Request addition of recommendation for genetic risk assessment/testing to the Initial Clinical Assessment algorithm for
More informationProstate Cancer. Dr. Andres Wiernik 2017
Prostate Cancer Dr. Andres Wiernik 2017 Objectives YES!!! 1. Epidemiology 2. Biology or Natural History of Prostate Cancer 3. Treatment NO!!! 1. Prostate Cancer Screening - controversies Which is the most
More informationCastrate resistant prostate cancer: the future of anti-androgens.
Castrate resistant prostate cancer: the future of anti-androgens. Dmitri Pchejetski 1,2*, Heba Alshaker 3, Justin Stebbing 3,4* 1. Department of Medicine, Imperial College, London, UK 2. School of Medicine,
More informationManagement Options in Advanced Prostate Cancer: What is the Role for Sipuleucel-T?
Clinical Medicine Insights: Oncology Consise Review Open Access Full open access to this and thousands of other papers at http://www.la-press.com. Management Options in Advanced Prostate Cancer: What is
More informationPresent and Future Perspectives in Treatment of mcrpc Patients
Present and Future Perspectives in Treatment of mcrpc Patients Pr Alexandre de la Taille CHU Mondor, Créteil INSERMU955Eq07 adelataille@hotmail.com Disclosures Astellas, Takeda, Janssen, Bouchara Recordati,
More informationNew Treatment Modalities and Clinical Trials for HRPC 계명의대 김천일
New Treatment Modalities and Clinical Trials for HRPC 계명의대 김천일 Castrate-Resistant Prostate Cancer (CRPC) Current standard therapy Androgen receptor (AR) in CRPC New systemic therapies Hormonal therapy
More informationRadical Prostatectomy: Management of the Primary From Localized to Oligometasta:c Disease
Radical Prostatectomy: Management of the Primary From Localized to Oligometasta:c Disease Disclosures I do not have anything to disclose Sexual function causes moderate to severe distress 2 years after
More informationSIMPOSIO. Radioterapia stereotassica e nuovi farmaci nel tumore e della prostata metastatico
SIMPOSIO Radioterapia stereotassica e nuovi farmaci nel tumore e della prostata metastatico Definition of Oligometastatic PCa 1-3 synchronous metastases (bone and/or lymph nodes) 2-5 synchronous metastases
More informationX, Y and Z of Prostate Cancer
X, Y and Z of Prostate Cancer Dr Tony Michele Medical Oncologist Prostate cancer Epidemiology Current EUA (et al) guidelines on Advanced Prostate Cancer Current clinical management in specific scenarios
More informationUpdates on Use of Radiopharmaceu3cals in Clinical Trials August 22, 2017
Updates on Use of Radiopharmaceu3cals in Clinical Trials August 22, 2017 Evan Y. Yu, M.D. Professor of Medicine (Oncology) University of Washington Fred Hutchinson Cancer Research Center Discussion Topics
More informationSaad et al [12] Metastatic CRPC. Bhoopalam et al [14] M0 PCa on ADT <1 yr vs >1 yr ADT
Evolution of Treatment Options for Patients with and Bone Metastases Trials of Treatments for Castration-Resistant Prostrate Cancer Mentioned in This Review Bisphosphonates (Zometa) 4 mg IV 8 mg IV ( to
More informationFarmaci e nuovi farmaci nel carcinoma della prostata: meccanismi di azione, integrazione nel tra7amento ed effe9 collaterali
Farmaci e nuovi farmaci nel carcinoma della prostata: meccanismi di azione, integrazione nel tra7amento ed effe9 collaterali Do7. Luca Triggiani Spedali Civili di Brescia Università degli Studi di Brescia
More informationThe Role of the Medical Oncologist in the Treatment of Prostate Cancer. Alireza saadat hematologist and oncologist
The Role of the Medical Oncologist in the Treatment of Prostate Cancer Alireza saadat hematologist and oncologist When should you see an oncologist? High risk localized disease Rising PSA after local therapy
More informationAnti-Androgen Therapies for Prostate Cancer: A Focused Review
Anti-Androgen Therapies for Prostate Cancer: A Focused Review Nischala Ammannagari, MD, and Saby George, MD, FACP Abstract Among men in the United States, prostate cancer is the most common malignancy
More informationModern Screening and Treatment of Advanced Prostate Cancer John Tuckey
Modern Screening and Treatment of Advanced Prostate Cancer John Tuckey Commonest male cancer - 2939 per year Third male cancer death 670 per year More die with it than of it but More people die of prostate
More informationACTUALIZACIONES EN TRATAMIENTOS DIRIGIDOS AL HUESO. COMBINACIÓN CON OTRAS ESTRATEGIAS TERAPÉUTICAS.
ACTUALIZACIONES EN TRATAMIENTOS DIRIGIDOS AL HUESO. COMBINACIÓN CON OTRAS ESTRATEGIAS TERAPÉUTICAS. ÁLVARO PINTO Servicio de Oncología Médica Hospital Universitario La Paz IdiPAZ, Madrid INTRODUCTION High
More informationTargeting the Androgen Receptor in Prostate Cancer. Raoul S. Concepcion, MD,FACS FDUS/Colorado Springs August 2017
Targeting the Androgen Receptor in Prostate Cancer Raoul S. Concepcion, MD,FACS FDUS/Colorado Springs August 2017 Consultant: GHI, CUSP, Tolmar, Integra Connect, Cellay, AZ Speakers Bureau: Dendreon, Astellas,
More informationA Forward Look at Options for. In Prostate Cancer
A Forward Look at Options for Prostate Cancer Charles J Ryan, MD Associate Professor of Medicine Helen Diller Family Comprehensive Cancer Center University of California, San Francisco UC 1 SF UC SF Castration
More informationCurrent role of chemotherapy in hormone-naïve patients Elena Castro
Current role of chemotherapy in hormone-naïve patients Elena Castro Spanish National Cancer Research Centre Lugano, 17 October 2017 Siegel, Ca Cancer J Clin,2017 Buzzoni, Eur Urol, 2015 -Aprox 15-20% of
More informationInitial Hormone Therapy
Initial Hormone Therapy Alan Horwich Institute of Cancer Research and Royal Marsden Hospital, London, UK Alan.Horwich@icr.ac.uk MANAGEMENT OF PROSTATE CANCER Treatment windows Subclinical Localised PSA
More informationUpda%ng Concepts Biosynthesis Inhibitors and An%- Androgens. Neal D. Shore IPCU 2017
Upda%ng Concepts Biosynthesis Inhibitors and An%- Androgens Neal D. Shore IPCU 2017 1 The Human Endocrine System Drives Prostate Cancer Growth Hypothalamus (Brain) Estrogen LHRH agonists (Lupron, Zoladex)
More informationProstate Cancer: Vision of the Future By: H.R.Jalalian
1 H. R. Jalalian Hematologist&Oncologist Baqiyatallah University of Medical Sciences 2 State of the art: vision on the future Diagnosis Surgery Radiotherapy Medical Oncology 3 Early Detection PSA sensitivity
More informationOligometastasis. Körperstereotaxie bei oligo-metastasiertem Prostatakarzinom wann und wie in Kombination mit Systemtherapie?
Körperstereotaxie bei oligo-metastasiertem Prostatakarzinom wann und wie in Kombination mit Systemtherapie? Daniel M. Aebersold 09. Dezember 2016 Oligometastasis JCO, 1995 1 Oligometastasis: Chance for
More informationAugust 2012 Volume 10, Issue 8, Supplement 12
August 2012 Volume 10, Issue 8, Supplement 12 A SPECIAL MEETING REVIEW EDITION Highlights in Advanced Prostate Cancer From the 2012 American Urological Association Annual Meeting and the 2012 American
More informationHave we optimized the use of Androgen Receptor pathway targeted drugs in Castrate-Resistant Prostate Cancer?
Have we optimized the use of Androgen Receptor pathway targeted drugs in Castrate-Resistant Prostate Cancer? Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France Disclosure Participation to
More informationProstate cancer Management of metastatic castration sensitive cancer
18 th Annual Advances in Oncology - 2017 Prostate cancer Management of metastatic castration sensitive cancer Urothelial carcinoma Non-muscle invasive urothelial carcinoma Updates in metastatic urothelial
More informationpan-canadian Oncology Drug Review Final Clinical Guidance Report Abiraterone Acetate (Zytiga) for Metastatic Castration-Resistant Prostate Cancer
pan-canadian Oncology Drug Review Final Clinical Guidance Report Abiraterone Acetate (Zytiga) for Metastatic Castration-Resistant Prostate Cancer October 22, 2013 DISCLAIMER Not a Substitute for Professional
More informationA SPECIAL MEETING REVIEW EDITION. Special Reporting on: PLUS Meeting Abstract Summaries. With Expert Commentary by:
August 2013 Volume 11, Issue 8, Supplement 11 A SPECIAL MEETING REVIEW EDITION Highlights in Advanced Prostate Cancer From the 2013 American Urological Association Annual Meeting and the 2013 American
More informationFrancesco Massari Oncologia Medica Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola-Malpighi
Prostata: Oral Communications Emerging strategies and controversial topics in advanced prostate cancer Francesco Massari Oncologia Medica Azienda Ospedaliero Universitaria di Bologna Policlinico S. Orsola-Malpighi
More information