Tools for Living Well with Prostate Cancer
Dr. Maha Hussain of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University discusses the latest treatment and research in prostate cancer and how prostate cancer patients and their loved ones can stay informed.
Dr. Maha Hussain:
So, with regard to recent developments relating to treatments that have been FDA approved and/or have promising early data that, hopefully, will lead to FDA approval, there’s been a fair amount of progress. So, since 2004, there have been numerous agents that have been approved by the FDA on grounds of survival prolongation in the setting of end-stage prostate cancer, specifically metastatic castration-resistant prostate cancer. A couple of those agents were moved earlier into the face of the disease, where specifically in the metastatic hormone-sensitive setting, which is the cancer has yet not been exposed yet to hormonal therapy. And the two drugs in that regard is Docetaxel and abiraterone and prednisone who were moved into that space, and they both demonstrated an overall survival prolongation which also led to expanding the FDA indication in this population.
There are drugs, however, that aren’t necessarily life-prolonging but they definitely have a clinical benefit. Examples would be agents like denosumab and zoledronic acid, both of which are not life-prolonging but certainly have reduced the damaging effect of the cancer on the bone and, therefore, were approved as supportive care type agents.
Now we have a large list of agents that are currently undergoing testing. Both, I think, of these agents are generally targeting two pathways. One of them is androgen-receptor targeted agents. That is being evaluated right now in clinical trials and phase 3 clinical trials, and the other class of drugs is the PARP inhibitors.
And I should point out that PARP inhibitors are agents that have been approved by the FDA for patients with breast cancer and ovarian cancer and at this moment are undergoing testing.
Several agents, actually, are undergoing testing specifically in advanced prostate cancer. There are other trials in early phase prostate cancer but there are definitely several that are being evaluated and have completed accrual and are about to be reported in the context of metastatic castration-resistant disease. So, I do think that the portfolio is expanding, and every time we have success that is really attracting more investment in terms of research in this field with the hope that we will come up with even better drugs as we move forward.
How Can Patients Stay Informed About Prostate Cancer News?
Dr. Maha Hussain:
Patients can access the National Cancer Institute’s website, they can access the American Society of Clinical Oncology website. Specifically, there is the cancer.net, which is geared specifically towards patients.
That is modules that are generally reviewed on a regular basis and has actually reviewed by both experts and patient representatives. Certainly, the American Cancer Society has information. The different foundations that are disease-specific like the Prostate Cancer Foundation, the Komen Foundation and so-on. So, there are multiple venues for patients to access the data. And, as I said, probably the biggest pool is going to be specifically the American Cancer Society.
Obviously, the obligation is definitely on the physician to inform the patient of what is available, recognizing fully that the media is full of information. And so, I definitely encourage patients always to make sure that they bring in the information and/or the questions to discuss with their doctors. And ultimately, a shared decision is made. Access to clinical trials is available but not every trial is available everywhere. So, several factors are to go into the process of considering participation in a clinical trial and certainly, for those of us in major centers, we tend to communicate with each other so that we can try to provide something to patients from another center or visa-versa and work with each other. And certainly, within the community, I, on a regular basis, get contact from physicians, oncologists in practice looking for potential opportunities for their patients. But as I said, the patient should not be shy. Ask your doctor.
Should Prostate Cancer Patient and Their Loved Ones Be Hopeful?
Dr. Maha Hussain:
Absolutely. I will tell you that some close to 30 years ago – so, that’s in our lifetime – certainly my lifetime – there weren’t many options for patients. And in fact, that’s what attracted me to the field of GU oncology and specifically prostate cancer. I worked in a VA hospital and in an inner-city hospital in Detroit, and we invariably encountered our first date with prostate cancer was pretty much end-stage patients presenting with multiple symptoms. And there was really not much to offer them other than castration, other than bilateral orchiectomy and of course, hormone therapy came in and kind of allowed patients the freedom of choice of what specific modality you want to choose. But at the end of the day, I would say, compared to the early 1990s and now, we have moved a huge, a huge way forward towards better treatments.
Now, still, for advanced prostate cancer, the disease is not curable yet. I actually am very optimistic. As we move these treatments into less aggressive phases of the disease, we’re seeing a better investment in terms of – return investment, I’m sorry – in terms of the outcomes. As a perfect example, moving Docetaxel and abiraterone prednisone into the hormone-sensitive population, one is able to get a much bigger, again, mileage or turn on investment so to speak with regard to disease control and overall survival.
The recent two agents that were moved in the setting of non-metastatic but castration-resistant disease, both apalutamide and enzalutamide, which both got FDA approval in that phase of disease. If you look at the magnitude of delay of metastasis from occurring is tremendous and that eclipses what we’re seeing, for example, in end-stage disease. So, I am confident at some point, as we get more and more data, many of these agents will be moved into even further earlier stages of the disease where cure becomes a potential. And I don’t think that’s going to be a long time from now. Ultimately, I do think it’s going to require investment and research and partnership between patients and physicians to try to conduct the necessary clinical trials to ensure that we have the cures of tomorrow possible.