An Expert’s Review of Advanced Prostate Cancer Treatment and Research

An Expert’s Review of Advanced Prostate Cancer Treatment and Research from Patient Empowerment Network on Vimeo.

What’s the latest in advanced prostate cancer treatment and research? Expert Dr. Tomasz Beer shares recent updates, and discusses how developing therapies could impact the future of prostate cancer care.

Dr. Tomasz Beer is Deputy Director at OHSU Knight Cancer Institute. Learn more here: https://www.ohsu.edu/people/tomasz-m-beer-md-facp.

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Transcript:

Katherine:

When it comes to prostate cancer research and emerging treatment options, what are you excited about specifically?

Dr. Beer:                     

Well, there is so much to talk about there. And I do want to say that the things that we’re excited about and that are promising, we want to present them in the proper light, meaning that they’re significant potential advances, but they’re not necessarily cures next year.

You know, we want to raise hopes and excitement at a proper level. So, I think right now, what we’re seeing is progress that is likely to yield drugs that will extend survival, will help us control the disease in a meaningful way. We’re not yet at a point where we can, for advanced prostate cancer, have a reasonable hope of cure in the near term. That doesn’t mean we’re not trying. We’re aiming high, absolutely.

But at the moment, the most exciting thing right in front of us, in my view, is lutetium 177-PSMA 617. That is a radioactive molecule attached to a binder that is specific to prostate-specific membrane antigen, PSMA, and essentially delivers this radioactive drug directly to prostate cancer cells by attaching to that target, the PSMA.

We recently completed and reported at ASCO and published in the New England Journal of Medicine the results of a Phase III trial, where we were able to show extension of life, extension of control of cancer, in a meaningful way, with this drug, and we’re eager to see the FDA’s review, and I think generally hopeful that the FDA will allow this drug on the market hopefully in the coming months. So, that’s a real tangible thing that is not just pie in the sky years away. I think it’s likely to be available sometime in less than a year, hopefully much less than a year. Speculating on those things is always a little risky, but –

Katherine:                  

Of course.

Dr. Beer:                     

– we all think that’s coming.

I think there are several other targeted drugs that may expand the portfolio of things that we can do in response to a mutational analysis. So, I mentioned microsatellite instability and DNA repair defects. There might be treatments for mutations in a pathway called AKT and others. And so, I think we’re going to see more very specific drugs that address segments of prostate cancer. And then a big area of activity that I’m very excited about is immunotherapy. And immunotherapy has been difficult in prostate cancer.

It has made more headway in melanoma and kidney cancer, and a number of other solid tumors, frankly, and we’re a little bit behind, and I think in part because natural prostate cancer doesn’t elicit quite as much of an immune response as some of the other tumor types; so, it’s not so easy.

But some of the newest technologies for synthetic antibodies are being designed that link the T cells from the immune system directly to prostate cancer cells and activate them, I think hold a lot of promise.

And ultimately, when it comes to cure, the immune system right now looks like the most promising strategy for actually eradicating cancer because once you activate the immune system, it can really do quite a job on cancer. Right now, for prostate cancer, that is still almost entirely in clinical trials and still for a minority of patients. So, this is not an answer for everybody, but once we get a hold of something that’s promising, I think the field’s going to work very hard to expand its utility and make it a reality for more and more patients.

 

Key Considerations When Making Prostate Cancer Treatment Decisions

Key Considerations When Making Prostate Cancer Treatment Decisions from Patient Empowerment Network on Vimeo.

What considerations are vital when making prostate cancer treatment decisions? Expert Dr. Tomasz Beer shares important factors that impact advanced prostate cancer care.

Dr. Tomasz Beer is Deputy Director at OHSU Knight Cancer Institute. Learn more here: https://www.ohsu.edu/people/tomasz-m-beer-md-facp.

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Transcript:

Katherine:          

What are the considerations when choosing treatment for advanced prostate cancer?

Dr. Beer:                     

Well, here, the considerations in advanced prostate cancer are first and foremost, what is the best treatment for this particular individual, right?

That’s what we want to do, and by the best treatment, I mean most effective with the fewest side effects, protecting their quality of life. But that’s an oversimplification. In reality, to arrive at what the best treatment is, we need to really understand quite a bit about the patient’s cancer. Sometimes it’s mutational status, as we discussed earlier, but also, the way it’s presenting, how aggressively it’s growing, is it involving the liver or lungs, or is it only in the bones, is it fast, is it slow.

And then the other thing that is extremely important is the patient’s health, other medical conditions. Some treatments are really more difficult to give when somebody has cardiovascular disease, or diabetes, or nerve damage, or other causes preexisting to the cancer treatment.

So, those kinds of things which we call comorbidities in the medical arena are really important in refining the risk-benefit ratio for each treatment. And finally, and critically, what prior treatments patients have received, that’s a major consideration. We obviously wouldn’t be using the same treatments again in many patients. There are exceptions to that, but for the most part, if a treatment’s failed once, it’s not likely to be of great benefit.

So, we integrate the cancer presentation, perhaps genomics in some situations, patient-specific health conditions, patient’s prior treatments, and then of course, patient’s values and personal priorities and what’s most important to them. And from all of that information, we take a look at the available portfolio and suggest one or two options, which we as physicians, based on our experience, expertise, and the knowledge of the literature, believe that fit most closely and are most likely to be successful.

Using Your Voice to Partner in Your Prostate Cancer Treatment Decisions

Using Your Voice to Partner in Your Prostate Cancer Treatment Decisions from Patient Empowerment Network on Vimeo.

How can prostate cancer patients work to become partners in their care? Expert Dr. Tomasz Beer discusses “shared decision-making” in prostate cancer care and offers his perspective about the patient role in treatment decisions.

Dr. Tomasz Beer is Deputy Director at OHSU Knight Cancer Institute. Learn more here: https://www.ohsu.edu/people/tomasz-m-beer-md-facp.

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Transcript:

Katherine:

The term “shared decision” is being used lately when talking about patient care. What does this term mean for you?

Dr. Beer:                     

Well, you know, at some level in my view, at least in the United States, virtually all medical decisions are shared decisions. We have a culture of advising our patients about their options, perhaps recommending a course of action, if it’s clearly preferable in our judgment to other options, but really involving patients in those decisions and taking serious consideration of the patient’s personal preferences and values.

And oftentimes in cancer care, especially when we’re dealing with noncurative treatments, treatments that are designed to keep the cancer at bay, perhaps shrink it, prevent or reduce cancer-related symptoms, protect quality of life, we really need to understand each individual patient’s willingness to undergo treatments, take on treatment-related risks, and their personal priorities. Is it their goal to live as long as possible and accept more risks? Is it their goal to focus on the quality of life today and avoid risks to the extent possible and only take them on when they’re absolutely necessary?

These are the kinds of discussions that we have with patients every time we consider a treatment change. So, to me, shared decision-making is really what we do with every patient and almost every visit. In some cases, it’s particularly important because there are areas in medicine where there’s really equipoise, and we don’t have a very clear recommendation one way or another.

Prostate cancer screening is an example for that. We all would dearly love to believe that early detection of prostate cancer is helpful, but early detection of prostate cancer comes with its own harms, the risk of overdetection, overdiagnosis, overtreatment, all because we pick up not just the aggressive cancers but also very slow-moving cancers that are not life-threatening. And so, folks undergoing cancer screening really need to know upfront what they’re getting into and make a decision about their view of the balance between the risks and the benefits. That’s a classic example of shared decision-making.

Katherine:                  

What is the role of the patient in making treatment decisions?

Dr. Beer:                     

Well, I think that the role of the patient is absolutely critical. I mean, they’re the ones receiving the therapy, and there are many things that we look for from our patients. To me, the most important is a clear understanding of their options and the reality within which we operate, having a set of hopes that are forward-looking, hopeful, and optimistic but also grounded in reality, so that good decisions can be made based on reasonable expectations. No. 2, a clear and honest articulation of the priorities, and that can be difficult.

You know, sometimes it’s hard to balance priorities. We obviously want to live as long as possible with a good quality of life. But what if the choice is better quality of life with a shorter lifespan or a longer lifespan but more side effects? And that’s really hard to sort out for some folks. And in my experience as a physician in the trenches, I can also tell you that sometimes the goals of the patients and the goals of their loving spouses and families are a little different.

And trying to help us – as physicians, our primary responsibility is to address the patient’s goals, but we all know that what we really want for our patients is a consensus of all the people they love that are important to them so that everyone can be supportive and on the same team. Those differences can be really stressful.

So, another thing that I look for in my patients and try to help with is building a family and friend support network that’s aligned, that’s on the same team, really. And then really strong communication with the physician or the provider about how things are going, letting us know about side effects honestly, and many people do that, but some people are afraid to share side effects for fear that their treatment might be taken away. And that honest, straightforward communication is really important for the best decision-making. And then, you know, of course, knowledge about the treatments and understanding of what we’re talking about is helpful, but actually, to me, it’s not the most important thing.

Having read the detailed papers on docetaxel chemotherapy while helpful, is not as important as having a really clear understanding of one’s values and priorities and a candid assessment of one’s quality of life and the ability to share that with a physician. I can cover the technical medical stuff, but what I can’t do is guess what’s important to my patients.  

 

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NCCN Guidance on Safety and Effectiveness of COVID-19 Vaccines for Cancer Patients

NCCN Guidance on Safety and Effectiveness of COVID-19 Vaccines for Cancer Patients from Patient Empowerment Network on Vimeo.

Is the COVID-19 vaccine recommended for people living with cancer? Dr. Erin Roesch shares recommendations from the National Comprehensive Cancer Network (NCCN) for those undergoing cancer treatment, including guidance on mask wearing and advice for family members.

Dr. Erin Roesch is a breast medical oncologist at the Cleveland Clinic. Learn more about Dr. Roesch here.


Transcript:

Katherine: 

Many cancer patients have questions about the COVID vaccine. Is it safe? Do we need to continue wearing masks? Here to address these questions is cancer expert, Dr. Erin Roesch. Dr. Roesch, would you introduce yourself?

Dr. Roesch: 

Hello. And thank you for inviting me to participate in this very important conversation. My name is Erin Roesch. I am a breast medical oncologist at Cleveland Clinic.

Katherine: 

Excellent. Thank you so much for joining us today. I’d like to run through a list of concerns that cancer patients have about vaccines in general and the COVID vaccine specifically.

So, let’s start with a basic question. Should people get vaccinated if they have cancer?

Dr. Roesch: 

Yes. All individuals diagnosed with cancer should get the COVID-19 vaccine as recommended by the National Comprehensive Cancer Network or NCCN.

An immunocompromised state makes many people with cancer at higher risk of serious COVID-19 illness. Those who are vaccinated are less likely to become sick with COVID-19. And, also, vaccinated people who do get COVID-19 are much less likely to become seriously ill.

I would also mention that those living in the same household as a person diagnosed with cancer and caregivers or other close contacts should also get vaccinated.

Katherine: 

Another common question is whether people with cancer should wait for any reason to get the COVID-19 vaccine.

Dr. Roesch: 

Most people with cancer should get the vaccine as soon as they can with a few exceptions according to NCCN.

People in the process of receiving stem cell transplant or cellular therapy should wait at least three months after they finish treatment to get vaccinated.

Those diagnosed with certain forms of leukemia should also wait a few weeks after receiving treatment to allow their immune system to recover so the vaccine can be effective.

It’s not been clearly defined exactly how chemotherapy affects responses to COVID-19 vaccines. But some data suggests that immune responses may not be as robust. However, it is still recommended that those receiving chemotherapy and also immunotherapy and radiation should get vaccinated whenever they can.

Katherine:

I think a lot of people are concerned too about whether one vaccine is better than another. What would you say to them?

Dr. Roesch:

And that is a common question that I often get in my clinic. And I advise my patients to receive or take whatever vaccine they are offered.

We don’t really have any studies or data at this point suggesting one being better than another in cancer patients.

Katherine: 

Some people are wondering if the vaccine can give a person COVID-19. How would you address that?

Dr. Roesch: 

I would say that as none of the currently available vaccines are made with a live virus, the vaccine itself can’t give a person COVID-19. By getting vaccinated, actually, those who are immunocompromised are really helping society to prevent the spread of COVID-19. Immunocompromised people who get COVID-19 may be more likely to infect others due to prolonged shedding of the virus after infection.

Katherine:

What about side effects? Are the vaccine’s side effects worse for people with cancer?

Dr. Roesch:  

No. Side effects do not appear to be worse for those diagnosed with cancer. Results to date suggest that the vaccine’s side effects in people with and without cancer are really no different.

These side effects, as we have seen, may include arm soreness, rash, fatigue, chills, fever, headache, for example.

Katherine: 

And, finally, can cancer patients stop wearing a mask after they’ve been vaccinated?

Dr. Roesch:

Cancer patients should continue to wear a mask post-vaccination. Many people with cancer may have a harder time actually fighting infections and may not respond as well to vaccines. So, people diagnosed with cancer and their close contacts should get vaccinated and then continue to follow precautions, which include wearing masks, social distancing, hand hygiene.

Katherine:

Is there a certain length of time that people need to continue wearing a mask after being vaccinated?

Dr. Roesch:  

At this time, I would recommend patients continue to follow the CDC guidelines that are currently in place. And at this point, I don’t think we have a projected end time for that yet.

Katherine:    

Is there anything else you’d like to share with cancer patients who may be concerned about vaccinations?

Dr. Roesch:    

I would encourage those diagnosed with cancer to not only themselves get vaccinated but to also really voice and stress the importance of vaccination to those that surround them, including, again, members of their household, close contacts, and even beyond their inner circle.

I would also advise people to try and avoid letting the concern of possible side effects related to the shot deter them from getting it. The symptoms of COVID-19 can be much worse and potentially serious for some compared with the relatively minor side effects that we’ve seen with the vaccine itself.

I also would mention I’ve had personal patients that have expressed concern about functioning of their immune system while receiving chemotherapy and how this might affect their response to the vaccine. I do emphasize to them that even though responses might not be as strong as they may be in the absence of active treatment, I feel like the potential benefits of the vaccine still outweigh the risks in my mind.

Katherine:   

Thanks so much for joining us today, Dr. Roesch.

Dr. Roesch:

Thank you for having me.

COVID Vaccines: What Do Prostate Cancer Patients Need to Know?

COVID Vaccines: What Do Prostate Cancer Patients Need to Know? from Patient Empowerment Network on Vimeo.

What do prostate cancer patients need to know about COVID-19 vaccines? Dr. Himisha Beltran shares information about safety, effectiveness, and recommendations for prostate cancer patients in active treatment. 

Dr. Himisha Beltran is Director of Translational Research in the Department of Medical Oncology at Dana-Farber Cancer Institute. Learn more about Dr. Beltran, here.

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Transcript:

Katherine:

Is the COVID vaccine safe and effective for patients with prostate cancer?

Dr. Beltran:

Absolutely. There really are no contraindications to getting the COIVD vaccine, unless there is some component of the vaccine that a patient cannot tolerate. And prostate cancer patients tend to be older. They can have their lower immune system if they’re getting chemotherapy. So, they’re at higher risk for having complications from COVID itself. So, I do think that it’s something to consider. There are even patients that are undergoing active therapy. They should, I think, consider getting the vaccine.

Katherine:

How does the vaccine effect treatment?

Dr. Beltran:

There should not be any delays or changes in therapy based on getting the vaccine.

An Update on Prostate Cancer Treatment and Research

An Update on Prostate Cancer Treatment and Research from Patient Empowerment Network on Vimeo.

What’s the latest in prostate cancer treatment and research? Dr. Himisha Beltran shares developments in precision medicine and clinical trials, including how prostate-specific membrane antigen (PSMA) imaging can help provide targeted care.

Dr. Himisha Beltran is Director of Translational Research in the Department of Medical Oncology at Dana-Farber Cancer Institute. Learn more about Dr. Beltran, here.

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Transcript:

Katherine:

Dr. Beltran, when it comes to prostate cancer research and emerging treatment options, what are you excited about specifically?

Dr. Beltran:

Well, there’s so much I’m excited about. There’s a lot happening in prostate cancer research. When it comes to precision medicine, we are still at the beginning. We are developing new trials and treatment strategies to target other mutations with drugs that have not yet been approved. We have the capability to interrogate treatment resistance, recognizing that tumors can evolve, and the technologies are such where we can start to understand why different people respond differently to the different treatments that we have, and now come in to try to prevent of bypass that treatment-resistant pathway, which is still a very new field.

I’m also very excited about even our understanding about the inherited mutations that predispose to prostate cancer because that has implications for family members, and one could envision a future where we have better detection and prevention for prostate cancer for high-risk individuals. And then, finally, one class of drugs that we didn’t talk about that is really precision medicine’s strategy is a class of drugs targeting PSMA – prostate-specific membrane antigen.

So, that is a molecular feature of the cancer. It is a protein that is expressed on the cell surface of prostate cancer. It’s not a genetic mutation that we test through genetic sequencing, but we have something called PSMA imaging where we can do molecular imaging to figure out if the prostate cancer expresses this protein. And there are a number of drug approaches that are coming in to target this very specific protein on the cell surface.

And so, I’m very excited about that. I do think that does represent precision medicine, and these are treatments in clinical trials that we’ll hear much more about later this year. And so, I think in general, as we start thinking about how we start treating prostate cancers, we’re moving beyond, “Treat everyone the same,” and really trying to figure out, “Can we really understand, who are the patients? And develop strategies that are more specific for that individual.”

How to Engage in Your Prostate Cancer Treatment Decisions

How to Engage in Your Prostate Cancer Treatment Decisions from Patient Empowerment Network on Vimeo.

What factors are important to consider when deciding on a prostate cancer treatment approach? Dr. Himisha Beltran reviews key considerations and highlights the important role patients play in their care.

Dr. Himisha Beltran is Director of Translational Research in the Department of Medical Oncology at Dana-Farber Cancer Institute. Learn more about Dr. Beltran, here.

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Transcript:

Katherine:

What are the considerations when choosing treatment for prostate cancer?

Dr. Beltran:

Yeah, so there are many considerations when thinking about a therapy choice for a patient with prostate cancer. Oftentimes, we use clinical features, radiology, blood tests, and now molecular features incorporating into that to really guide care based on how indolent or aggressive the cancer is. There are some cancers that don’t need to be treated that we follow on active surveillance. There are different states where we may do intermittent treatment, weighing the risks and benefits of the therapy.

And then, in the more advanced setting where you need continuous treatment – and there is now many choices of different drugs that are approved for prostate cancer – we often make these choices with our patients based on not just the trajectory of the cancer but also weighing the side effects and quality of life and other issues for those different treatment modalities. And I see precision medicine as providing one extra layer of information to help guide those conversations.

Katherine:

What’s the patient’s role in making treatment decisions?

Dr. Beltran:

The patient is the center. It’s really our role to help inform and partner with them because now we have a lot of choice. And one choice might not be the same for each individual. And so, we use clinical features and features of the cancer, but the other features factor, such as quality of life. It factors cost considerations – the logistics of it all. These can vary across the different treatments. And so, it really requires really going through everything with the patient. And the patient really does have a voice and really should be the center of that treatment decision.

Prostate cancer treatment is complex, and sometimes there are questions there are questions that a patient might have that their physician did not answer adequately. And they really should speak up because it’s important to know what all the options are. There are even things like the DNA sequencing. It can be difficult to interpret. And you may not know what available treatments are there unless you ask the questions.