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Updates on Advanced Prostate Cancer Management - ESMO 2016

Guest Speakers: Prof. Eleni Efstathiou and Dr. Nina Tunariu

(Live event filmed in Copenhagen), Denmark, 9th October 2016)

  • Updates on Advanced Prostate Cancer Management - ESMO 2016 - Introduction

    In this session, the host introduced the expert speakers, Prof. Eleni Efstathiou, who is an associate professor, Genitourinary Medical Oncology at University of Texas M.D. Anderson Cancer Center, Houston, USA; and assistant professor at the department of therapeutics at University of Athens Medical School, Greece. She has received the Young Investigator and Career Development Award from the Prostate Cancer Foundation and has published over 100 peer-reviewed papers.

    Dr. Nina Tunariu, is a Consultant Radiologist at the Royal Marsden Hospital and Institute of Cancer, London, UK. In 2014, she has been awarded an MDRes for the thesis entitled “Standardisation of Data Analysis Methods for Multiparametric MRI in Phase I clinical trials” by the University of London.

  • Practice shaping data: CHAARTED and FIRSTANA trials

    Prof. Eleni Efstathiou  and  Dr. Nina Tunariu in this session discussed about the importance of multi-disciplinary approach in the management of prostate cancer. They discussed specifically about the role of imaging in the appropriate diagnosis and determination of response to therapy. With the help of the results of CHAARTED trial  and FIRSTANA trial they tried to point out the need for appropriate imaging  at regular intervals so as to help tailor therapy especially in patients with high-volume disease or advanced prostate cancer.

  • PREVAIL trial: post-hoc analysis update

    The experts discussed the results of the post-hoc analysis of the PREVAIL study which showed that there is a subset of men in whom there is radiological progression even when the prostate specific antigen (PSA) limits are in the range. They further discussed the importance of reimaging in such scenarios and the schedule of reimaging that should be followed. They emphasized on the need for standard guidelines for imaging in the management of prostate cancer.

  • Biomarker/Drug/Therapy development

    In this session, the speakers discuss the current developments in biomarkers and their usefulness in deciding the drug therapy in cancer patients. The focus of the discussion is phosphatase and tensin homolog (PTEN) expression loss study whose primary aim was to assess radiographic progression-free survival ( rPFS) in patients with PTEN loss. The discussion mentions combining Akt inhibition with androgen receptor blockade may improve rPFS in patients with mCRPC and that PTEN loss may be a predictive biomarker of response in patients with mCRPC.

  • Immunotherapy: KEYNOTE-028 trial

    In this session, the speakers discuss the reasons for failure of immunotherapy in prostate cancer. The speakers also analyze the overall response rate in the KEYNOTE trial with pembrolizumab monotherapy. They refer to interesting observations in this study such as none of the patients died or discontinued pembrolizumab due to treatment-related adverse events and the demonstration of anti-tumour activity and favourable safety profile.

  • Imaging

    In this session, the speakers discuss the uses and clinical trials of Radium 223 therapy . They discuss the key issues in imaging in advanced prostate cancer. They also discuss  patient selection (low- versus. high-volume disease, oligo- vs. polymetastatic disease, aggressive disease detection), treatment benefit (radiographic progression-free survival, lack of bone metastases response on imaging criteria, emerging prostate-specific membrane antigen [PSMA]-targeting molecules as treatment under development). They mention that whole-body magnetic resonance imaging (MRI) - diffusion-weighted imaging (DWI) has potential as ‘one-stop shop’ instead of MRI prostate + CT + bone scan. On comparison of PSMA with whole body markers, Dr. Tunariu mentions that PSMA gives detection while whole body markers give information about response to therapy. They discuss that bone scan has  limitations such as being more sensitive to progression than response, assessment of hydroxyapatite deposition but not to cancer, qualitative rather than quantitative, subject to flare-ups. The Prostate Cancer Working Group (PCWG) criteria focus not on imaging but on biomarker development and presence of absence of two new lesions. 

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