What Is Precision Medicine for Prostate Cancer?

What Is Precision Medicine for Prostate Cancer? from Patient Empowerment Network on Vimeo.

 Prostate cancer has the option of precision medicine in the treatment toolbox. Dr. Heather Cheng from Seattle Cancer Care Alliance defines precision medicine and explains how it is used to help provide optimal prostate cancer care.

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Transcript:

Sherea Cary:

So, what is precision medicine? And what…and what is precision medicine when we think about prostate cancer?

Dr. Heather Cheng:

Yes, it’s a great question and something I get really excited about. So, precision medicine, I guess in a nutshell would be finding out more about somebody’s personal prostate cancer and being more precise about our treatment decisions, meaning using that information to avoid overtreating or using drugs or treatment that don’t work and choosing treatments that we have a much higher level of confidence will be effective. Now, that’s the potential, sometimes we’re more successful than other time, but in prostate cancer, we have a few exciting examples that are, I think that are new, that I think just get me really excited because, for example, some cancer…some people, cancers have certain mutations or markers in them, that if they’re there, which is not in all people with prostate cancer, but if they’re there, then we have a different treatment tool box for those patients, so we have new extra, extra drugs or extra treatment opportunities, and that’s the sort of precision aspect or tailoring or we’re making the treatment it better for the patient and their cancer, and that’s really exciting, so it’s not one-size-fits-all, but kind of more tailored to the patient and their particular cancer.

New Developments in Prostate Cancer Care

New Developments in Prostate Cancer Care from Patient Empowerment Network on Vimeo.

Prostate cancer care has seen some recent developments. Dr. Heather Cheng from Seattle Cancer Care Alliance shares updates that are likely to be shared at the American Society of Clinical Oncology (ASCO) conference and a recent treatment approval.

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Transcript:

Sherea Cary:

Are there any exciting developments being presented at the upcoming ASCO conference that you can share with us?

Dr. Heather Cheng:

Yeah, I think one of the most recent, really exciting…there are many, it’s hard to pick just one. As a medical oncologist, I’m probably paying more attention to the Phase III clinical trials in the more advanced disease, meaning for patients who have metastatic cancer, cancer of the process started in the prostate that spread to other parts of the body. There are trials that show that the combination of effective drugs that we currently use in the latest stages of prostate cancer, metastatic prostate cancer, we are moving them earlier in the disease spectrum, meaning we are not waiting until the end when people are really sick. We’re trying to use them earlier, and we’re trying to use them in combination with each other to improve the outcomes of men with advanced prostate cancer, so men with prostate cancer that has spread outside the prostate can actually now live longer than they ever have ever before, which is really, really exciting. We do need to be thinking about side effects, but some of the newest strategies are, for example, trying to understand how we can use immunotherapy more effectively, so many people may be aware that immunotherapies are manipulating the immune system, is really effective in some types of cancers, and they have different side effects than chemotherapy, most of the time, they have fewer side effects that they occasionally can have pretty serious side effects, but as a general strategy, it’s very exciting in oncology to say, Can we encourage your own immune system, your defense system, your built-in defense system, to be more effective in addressing cancer without as many of the side effects. If we could do that, we would really be in a much better place, and for prostate cancer, it hasn’t historically been as effective, but many of the strategies now are trying to understand how can we manipulate the system and maybe give different combinations so that that works just as well as it does for some of the other cancers.

So, that’s number one, number two is thinking about this idea of precision oncology or tailoring the treatment to the person’s cancer are based on the genetics of their cancer and genetics of the patient, and we already have some examples now of how that’s really exciting and effective, and I think then the third strategy the third approach that I’m really excited about is these drugs that are what we call targeted radiation therapies, or there’s the drug called lutetium  [Editor’s note: Pluvicto is now approved] that is likely to be approved soon, where there is a radiation molecule that is linked or tagged to basically a homing device. So, it’s an antibody, which is something that is made by the body’s immune system, but basically hones in on any cell in the body that expresses this tag called prostate-specific membrane antigen, so you’re taking a smart delivery of radiation just to those cells, not to the other cells. So, it’s hopefully not going to have as many side effects, but it’s going to be really effective, so those are the kind of maybe in a high level over some of the things I am really excited about, and always there’s more progress and more to talk about, so hopefully, I can tell you about it again.

Sherea Cary:

Thank you. I find the information that you are providing about smart medicine very informing, and I think it can be used to help promote education in the community when we want to talk about prevention because when we talk about cancer, this…there’s this overwhelming feeling about it, and there’s sometimes a feeling of no hope, but when we put out more information about there’s ways that treatment can be targeted and where we can do prevention, if we find out early, treatments can be different and you can continue on with your life, I think that that makes a huge difference. And the more information that is provided about smart technologies for medical treatment is going to make a difference in the area of educating patients and caregivers about prevention and the importance of prevention.

Dr. Heather Cheng:

Absolutely, I think actually the most exciting thing about what I do is not necessarily the targeted precision treatments that I mentioned, what I get most excited and passionate about it is the fact that if those mutations are genetic, then what can we do for the brothers, for the sons, for the nephews, that can change things so that they don’t have to have those late-stage medications that we find the cancer early, we cure the cancer, so that it’s a non-issue. And I think that’s possible. We have to start somewhere, but I think we can definitely see benefit at the advanced disease setting, but I’m most excited and hopeful for the earlier… The sort of people who might be at risk where we can do something.  Just as you said, screening prevention…knowledge can be power. Knowledge doesn’t need to be a burden.  

Prostate Cancer Treatment Tools and Advancements

Prostate Cancer Treatment Tools and Advancements from Patient Empowerment Network on Vimeo.

What’s the latest in prostate cancer treatment tools and advancements? Dr. Heather Cheng from Seattle Cancer Care Alliance shares information about areas of prostate cancer research that have experienced recent advancements.

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What Is the PROMISE Study for Prostate Cancer Patients?


Transcript:

Dr. Heather Cheng:

I think it’s a really exciting time. I think there are a lot of advancements throughout prostate cancer. I think one area of importance is early detection, but we also have newer imaging platforms, meaning the way, and we can discover where the prostate cancer is, is advancing through new types of PET scans that we didn’t previously have. And then my own kind of research which is near and dear to my heart is talking about genetics and what we have learned about the genetics of the risk of prostate cancer, but also how the genetics of the cancer itself, which sometimes is inherited, and sometimes isn’t can help us plan for better treatments for patients.

Understanding New Targeted Therapies for Prostate Cancer

Understanding New Targeted Therapies for Prostate Cancer from Patient Empowerment Network on Vimeo.

Which prostate cancer therapies are experts excited about? Dr. Heather Cheng from Seattle Cancer Care Alliance shares information about recent treatment advancements and how the therapies are utilized to help provide optimal prostate cancer care.

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Transcript:

Sherea Cary:

So, Dr. Cheng, share with us some of the new treatments that you and your colleagues are excited about? 

Dr. Heather Cheng:

Thank you. So I am a medical oncologist, I specialize in genetics, most of my patients have more advanced prostate cancer, meaning they have had surgery to remove their prostate, but then their cancer continued to grow or that they have radiation and their cancer continued to grow, and we are…then looking at treatments that are medical, and by that I mean they are given through a pill, or they’re given and through an injection and they travel throughout the body and treat the cancer…wherever the cancer is.

And I think what I get very excited about is that we have new targeted therapies, and by that I mean some of my patients to have certain mutations in their cancers or DNA changes in their cancer, have access to newer treatments like a pill, for example, called in a family called PARP inhibitor, that are really especially effective against cancers that have that type of mutation. So can’t we learn about this whether it’s a good fit or whether that person’s cancer might especially be well treated by that drug by doing DNA sequencing of the cancer or DNA sequencing of that person’s DNA, inherited DNA. So, both of those can give us clues about this kind of special treatment toolboxes that I get very excited about, and so I think that’s the frontier in oncology, but also in prostate cancer as well.

Top Tips and Advice for Prostate Cancer Patients and Caregivers Navigating Treatment

Top Tips and Advice for Prostate Cancer Patients and Caregivers Navigating Treatment from Patient Empowerment Network on Vimeo

What should prostate cancer patients and caregivers know about prostate cancer treatment? Dr. Leanne Burnham shares advice for patients with concerns about treatment side effects, information about active surveillance, and some specific advice for Black men with prostate cancer.

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Transcript:

Dr. Leanne Burnham

Yes, so it is a couples’ disease for sure, and you want to make sure to do a little bit of your own research. Make sure that your doctor knows how this disease affects Black men differently, because what I see a lot of time, even in my own family, my husband’s family members that get prostate cancer and they come to me, a lot of times, their doctor will recommend active surveillance. And it may not be appropriate for African American men if you look at the research and you look at the studies. And so, it may benefit you to just ask your doctor, “Do you treat a lot of Black patients, or do you see any difference in their survival rates versus your other patients?” And really consider that when you’re thinking about whether to do active surveillance or not. Once it gets time for treatments, one thing when I — because I talk to a lot of men and support groups, and men are scared, they don’t want to lose their urinary function, they don’t want to lose their sexual function. And so, they’re nervous about certain diseases and in terms of surgeries and radical prostatectomy, there are nerve-sparing surgeries now to really protect that function afterwards, and there are exercises that can be done afterwards to also help improve, and so ask the nurses in your setting, “What are some of those exercises that can be done?” But one thing to keep in mind is every treatment comes with its sort of risk, right?

So, no matter whether you choose radiation or surgery, there’s always a risk that you may lose some of that function, what I tell men, and not to sound not sensitive to the matter, but a lot of men, they’ll say, you know, “Oh, if I get this treatment and what if I can’t have sex anymore?” You’re not going to have sex when you’re buried 6 feet underground either. And so, you want to be able to get those treatments, the ones that you and your physician have a shared decision in and in deciding what’s best as a couple. But you don’t want to be naive if you’re at the doctor and you have a really elevated PSA and you have a Gleason score of 8, and your doctor is telling you, “We really need to treat this,” you don’t want to shy away from that, because you’re scared of the side of the side effects in that setting. You can look for where the best surgery center is if they have the nerve-sparing surgery, as I said, and explore your options that way. But don’t put it off so long, because you’re worried about the side effects. And if you don’t get treatment and your doctor wants you to, as time goes on, you’ll lose the urinary function and the sexual function anyways.

So yeah, it’s not something that you want to put off because you’re scared about the side effects. And a lot of men do have side effects temporarily, and then they regain their function, and I really encourage to join support groups virtually now because of how the role is set up. But just talk to some other men that have had some of these procedures and see how they’re doing. And I personally haven’t met a man that felt like, “Oh, I have been cured from prostate cancer, and now I have the side effects, and I wish I wouldn’t have had the procedure,” I haven’t met one. And I know in those who have side effects and they had surgeries and 10, 15 years ago, and they have side effects, I’m not going to act like that doesn’t happen. But none of them have ever expressed to me that they wish they could go back in time and not do that, because, at the end of the day, they’re grateful that they are still here with their loved ones.

How Will Telemedicine Impact Prostate Cancer Clinical Trials?

How Will Telemedicine Impact Prostate Cancer Clinical Trials? from Patient Empowerment Network on Vimeo

How will prostate cancer clinical trials be changed by the addition of telemedicine to the treatment toolbox? Expert Dr. Leanne Burnham details patients who can benefit from telemedicine visits — and explains some of the history of discrimination in medical care for BIPOC patients and treatment response of African American men with prostate cancer

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Transcript:

Dr. Leanne Burnham

So clinical trials, the whole concept of clinical trials has really come to the forefront of the media right now with everything that’s happened in 2020 and currently with COVID.

And so a lot of people, if they were not aware of discrimination in medical care or clinical trials in the history of the U.S., then now they’re starting to become well-versed in it. So now people are hearing, “Oh, Tuskegee syphilis experiment,” where those of us who are in science, in medicine study health series research is, this is not new to us, so we’re grateful that it’s coming to the forefront. People are learning about it, but there is a justifiable medical mistrust by many Black and Brown people, but African Americans in particular, because of what has been done and not done in terms of medical treatment in the past 400 years. And so, because of this medical mistrust, that leads to sometimes a hesitancy to participate in clinical trials, because there’s an idea of, I don’t want to be a guinea pig, so that’s just one aspect that leads to less enrollment in clinical trials. There’s the whole other side of things, right? There’s the fact that a lot of African American patients are not asked to be in a clinical trial, they’re not explained what the clinical trial entails, a lot of people don’t realize that clinical trial patients have access to what I call what I consider to be VIP access to what is cutting-edge, and it doesn’t mean that it’s not new, that it hasn’t been tested extensively. It’s just now that it’s available to a patient at a particular disease stage that we might be looking at, and we have a lot of reason to believe that it will help that patient.

So a patient that’s enrolling in a clinical trial has access to the VIP treatment. And then as an added bonus, they actually have extra engagement with providers, extra touchpoints with their providers that patients that are receiving standard of care and not enrolled in a clinical trial don’t have as much access to. That being said, in addition to that, for us to really forward medicine in what we call precision medicine, which is able to have medication that’s tailored to an individual person based on their DNA makeup, based on how their body would individually respond to a drug. It’s super important, highly important that we have diversity in patients that are enrolled in clinical trials. For example, if you don’t have enough African American men enrolled in the clinical trial for prostate cancer, then you don’t really know if that medication would work worse or even better in that patient. And what we’re actually seeing is there has been a development of race-stratified clinical trials in the past less than 10 years, really around five years, where we’ve looked at chemotherapy, we looked at hormone therapy, and we looked at immunotherapy, where we include enough African American men in the trials, and we look at how the drug responds in African American men versus other men. And we see that African American men actually have a better treatment response than other races, so how amazing is that? Where you have a demographic that is more likely to get aggressive prostate cancer and die much younger, and we’re seeing that if they’re given the new treatments that are really tailored to target the disease in ways that we weren’t able to do it before, that they’re responding better and having longer survival and better outcomes. And so it’s really important for all those reasons I described to increase African American participation in clinical trials.

Now, I say all that to get to this point, which is, enrollment is not easy when you don’t live near a clinical trial center or a hospital that’s offering whatever treatment you’re interested in trying out as part of a trial. And so we know that race in this country is tied to geographic location, it’s tied to socio-economic status, and so what telemedicine provides is in previous instances where maybe a patient lives out the way 60 miles or more from an institution that has a clinical trial that they would want to be involved in, now they don’t have to drive to that center. They can have a telemedicine visit, they can conduct labs where they’re at near their home, see if they qualify to participate in the clinical trial based on their own body’s physiology and how their blood work comes out and how their imaging comes out, see if they qualify. And then they can enroll in that clinical trial, and so telemedicine in that aspect really opens the door to people who may have been interested who live out of the way, maybe even in a rural setting where the institutions that they have nearby, don’t have what they are interested in using or what may be best for their treatment plan personally, and so telemedicine opens a whole new world to patients such as those.