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Key Questions for Prostate Cancer Patients to Ask Before Joining a Clinical Trial

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Key Questions for Prostate Cancer Patients to Ask Before Joining a Clinical Trial from Patient Empowerment Network on Vimeo.

Dr. Andrew Armstrong, director of prostate cancer research at the Duke Cancer Institute, provides expert advice on what questions prostate cancer patients should ask when considering participation in a clinical trial. 

Dr. Andrew J. Armstrong is a medical oncologist and director of clinical research at the Duke Cancer Institute’s Center for Prostate and Urologic Cancers. For more information on Dr. Armstrong here.

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Transcript:

Katherine Banwell:

What are some key questions that patients should ask their healthcare team before even participating in a clinical trial?  

Dr. Armstrong:

I think number one is what are the alternatives that I would have if I did not participate in the clinical trial? What are the standard of care therapies? And prostate cancer now has a vast menu. There is two different types of chemotherapy. There are two different types of target radiotherapy, that’s Pluvicto and radium. There’s immunotherapy, with Sipuleucel-T and other immune therapies. There are multiple hormonal drugs. There are precision medicines, like I mentioned, for men with certain hereditary types of prostate cancer. So, it’s important to hear what the standard of care is, and many patients don’t necessarily even hear that. 

And then based on what patients have already seen and what’s the expectation? Risks and benefits around those. 

And then on top of that, research can complement that or either replace or come after those standard of care approaches. Certainly if a patient has exhausted the standard of care approaches, a trial can offer real benefits. 

It’s important to ask about risks. What have other patients experienced going into that study? What kind of toxicities, good or bad? What other – what’s the evidence that it has helped people before? If it’s never been studied in people, the evidence might just come from the laboratory. But hearing about why is this so promising, why have you chosen to invest so much time and energy in this trial, is a good question. 

And then if you’re hearing about a trial and you’re making a decision to travel, sometimes asking questions about whether the trial will cover your lodging or transportation, gas money, airport travel. Some trials do do that. 

You can also look on clinicaltrial.gov for sites that are near you. So, many centers open the same trial in a different state, so you can look on that website to see if there’s a trial near you for what you’re looking for.  

Should Prostate Cancer Patients Consider a Treatment in Clinical Trials?

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Should Prostate Cancer Patients Consider a Treatment in Clinical Trials? from Patient Empowerment Network on Vimeo.

Prostate cancer expert Dr. Andrew Armstrong explains how prostate cancer clinical trials work and discusses why patients should feel confident exploring this option at any stage of their cancer journey.

Dr. Andrew J. Armstrong is a medical oncologist and director of clinical research at the Duke Cancer Institute’s Center for Prostate and Urologic Cancers. For more information on Dr. Armstrong here.

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 Key Questions for Prostate Cancer Patients to Ask Before Joining a Clinical Trial

Key Questions for Prostate Cancer Patients to Ask Before Joining a Clinical Trial

Transcript:

Katherine Banwell:

At what point should a prostate cancer patient consider participating in a clinical trial? 

Dr. Armstrong:

Sure. If you look at the National Comprehensive Cancer Network, NCCN guidelines, you’ll see that clinical trials should be discussed along all parts of the journey. 

And that’s because clinical trials often can change how we think about cancer, how we treat cancer, can improve cure rates, can improve survival. Most of our drugs and treatments that have been successful in all cancer have been the result of clinical trials. 

And it’s not always appropriate, though. We have very many treatments that can cure patients, and we don’t want to interfere with that, but sometimes a clinical trial can layer on top of that cure rate. 

But many patients, their cancer becomes resistant to proven therapies. That’s certainly an area where clinical trials can make a big difference, either to put off chemotherapy or more toxic therapies, or in patients who have exhausted proven therapies. That’s certainly appropriate. 

But sometimes clinical trials do not involve placebos. They involve combination therapies, they involve layering on top several approaches to try to improve the survival on top of standard of care.  

And so as a director of a research program, we have all sorts of trials. They come in Phase I, Phase II, Phase III. Really only the Phase IIIs involve placebo controlled or controlled trials. Phase II tend to be early studies, where everybody gets a therapy and it’s preliminary to determine efficacy. Phase I is really trying to determine the safety and dosing of an experimental drug. But patients can benefit across the spectrum. 

So, it’s important, particularly if you have advanced disease, to go to a site, like a comprehensive cancer center, for a second opinion to see if there is alternatives to what you might get in the community.  

Katherine Banwell:

Yes. What would you say to someone who might be hesitant to participate in a trial? 

Dr. Armstrong:

Participation in a trial involves shared decision-making, just like being diagnosed, embarking on initial treatment, even embarking on standard of care treatment. Everything is shared decision-making in terms of risks and benefits.  

Sometimes a trial is not in a patient’s best interest, and it’s important for a physician to be upright about that and up front about the risks of a trial. 

I think when patients have exhausted proven therapies, it’s quite appropriate to talk about therapies that might be in the research pipeline that are showing some promise, that have demonstrated at least success in the laboratory or in small numbers of patients coming before.  

For example, in 2022, a brand-new drug just got approved called Pluvicto, or PSMA lutetium. This is a new smart bomb for prostate cancer. Just last year it was a research drug, but this year it’s successful and being used in the clinic. All those hormone drugs I mentioned earlier, those were research drugs five years ago. So, we don’t make advanced, we don’t extend lives without participating in research. We’re not happy with the way things are, we want them to be better. 

And the only way to make them better is by studying them. And not all of these trials are successful, unfortunately, but many are, and that’s why we are seeing men live longer and have better survivorship nowadays. 

Prostate Cancer Research Highlights From ASCO 2022

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Prostate Cancer Research Highlights From ASCO 2022 from Patient Empowerment Network on Vimeo.

What should prostate cancer patients know about developing research? Dr. Rana McKay reviews news from the 2022 American Society of Clinical Oncology (ASCO) meeting.

Dr. Rana McKay is a medical oncologist at UC San Diego Health and an associate professor in the Department of Medicine at the UC San Diego School of Medicine. Learn more about Dr. McKay, here.
 
 

Katherine Banwell:

ASCO was held in June. Is there news from the conference that patients should know about?  

Dr. Rana McKay:

Yeah. So, I think some of the biggest therapies in prostate cancer that was one of the newest therapies that was just FDA-approved is Lutetium PSMA. It’s a radioligand therapy that targets specifically PSMA-expressing cells. It delivers a little bit of beta radiation to those cells. That therapy was approved this past spring, and there highlights at ASCO about the utility of this therapy. And again, there’s a series of novel compounds that are being tested in prostate cancer not yet ready for prime time but a lot of exciting work that’s being done to try to get new drugs that work better for our patients.  

Katherine Banwell:

Mm-hmm. Going back to ASCO and new developments, how can patients stay informed about research developments like – like these that happen at ASCO. 

Dr. Rana McKay:

So, very – very good. I think there’s a lot of networks for people with prostate cancer. I think one like I mentioned, the prostate cancer foundation it’s a wonderful community. That really focuses on making sure that up to date, you know, evidence-based data is distributed to patients in a manner that is – that makes sense. That’s there’s not a lot of medical jargon and so I think that the PCF is really a wonderful resource. ASCO itself also has, you know, patient interfacing, you know, materials through their website.  

American Cancer Society does as well. The American Cancer Society can also be a wonderful resource for patients that are newly diagnosed or going through treatment.  

Katherine Banwell:

It seems like there’s a lot of progress and hope in the field which is good. Dr. McKay, thank you so much for taking the time to join us today.  

Dr. Rana McKay:

Of course. My pleasure.  

Understanding Advanced Prostate Cancer Treatment Approaches

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Understanding Advanced Prostate Cancer Treatment Approaches from Patient Empowerment Network on Vimeo.

What approaches are available to treat advanced prostate cancer? Dr. Rana McKay discusses advanced prostate cancer treatment goals and reviews current options for patients.

Dr. Rana McKay is a medical oncologist at UC San Diego Health and an associate professor in the Department of Medicine at the UC San Diego School of Medicine. Learn more about Dr. McKay, here.
 
 

Katherine Banwell:

We’re going to talk about treatment approaches. But first, how would you define treatment goals? 

Dr. Rana McKay:

So, you know when I look at defining treatment goals it’s focusing on what do we want to achieve from the standpoint of the cancer? Meaning, you know, what are objectives that are associated with patients living longer?  

And then what are objectives and strategies that we can set-up to make sure that patients are living better? So, I think the treatments are basically set up to basically help you achieve those two goals. What can we do to help you live longer and feel better? 

Katherine Banwell:

Yeah. Well, let’s walk through the types of treatments that are used today to treat advanced prostate cancer. What are the treatment causes and who are they appropriate for? Let’s start with surgery, for instance. 

Dr. Rana McKay:

So, surgery is something that’s utilized early on when people are diagnosed with cancer. It tends to be utilized when the cancer has not necessarily spread to other parts of the body but is still localized within the prostate itself, or maybe there’s just some little bit of breakthrough in the capsule. Sometimes it can be used in people who have involvement of the prostate cancer in the lymph nodes. But it’s generally not utilized in people who have cancer that’s spread to other parts of the body. 

Katherine Banwell:

Mm-hmm. What about other treatment classes? What are they? 

 Dr. Rana McKay:

So, radiation can also be utilized. Radiation is a treatment modality that can be used for people with localized disease, and also it can be utilized for people with advanced disease to treat the primary tumor. 

Additionally radiation therapy can be used to help treat symptoms if there’s a bone lesion causing pain or other areas that are causing discomfort. Sometimes radiation to those areas can mitigate pain. When I think about the treatment classes for prostate cancer, they generally break down into several categories. The first, most predominant category is the hormonal therapy category. Hormonal therapies are really the backbone of treatment for men with prostate cancer, and they include the more traditional hormonal therapies that really work to just drop testosterone. So, just LRH – L – LRHA agonists and antagonists and also, they include newer hormonal therapies in the form of pills that really target strategies at also affecting testosterone function and testosterone production. Another class is also the chemotherapy agents. There are two FDA-approved chemotherapies for prostate cancer that are life-prolonging, and there’s a certain role for chemotherapy for people with advanced disease. 

There’s also immunotherapy that can be utilized. There’s a vaccine therapy that’s actually one of the first FDA vaccines for any solid tumor that’s proving in prostate cancer that can be utilized. There’s also radio pharmaceuticals.  

So, these are specific agents that deliver bits of radiation to specific areas. Whether it be radium 223, which targets the bone or the newest radio pharmaceutical, which was approved called Lutetium PSMA that basically delivers beta-radiation to little – sites of PSMA expressing cancer cells and the last category that I would highlight is the category of targeted therapy. There are two targeted therapies for prostate cancer for patients who have like genomic alterations. Those include the drugs olaparib and rucaparib. So, as you can see there’s a wide spectrum of drugs that can be utilized to really keep this disease at bay.   

New Developments in Prostate Cancer Care

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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.