Hi, I'm Dr. Scholz. Let's talk about prostate cancer.
In this video, we're going to cover clinical trials, and it's appropriate in the section
on Royal. Royal is advanced prostate cancer. Clinical trials are reserved for people who
are running out of other options—standard FDA approved treatments—and I'll explain
why that typically is the case. So a sequence of going through standard therapy until those
types of treatments are no longer working, followed up by looking for a good clinical
trial as a way to treat or control the cancer is a very logical sequence.
Looking for clinical trials—the right clinical trial for you—is an art, and it starts by
allowing yourself adequate lead-in time. When people are in the stage of Royal they need
to be thinking in terms of next steps, even though the treatment you're on presently is
working. You should have a plan if the treatment stops working, and you don't want to be scurrying
around at the last moment looking for answers, so as you're doing well on one treatment you
should be having discussions with your physician about what the next step should be.
This is particularly challenging with clinical trials because they open and close quickly
and it may be difficult to find out where certain agents are, and they may be available
in one part of the country at one juncture and then close and open up in another area.
So many times this process will rest on your shoulders. One great resource is a website
"ClinicalTrials.gov" . The clinical trial world is complex and you as an untrained patient
probably won't be able to pick the specific trial that's optimal for you, but there's
so much legwork to be done and you can gather different potential trials in your own research
and then use that information to aid your physician in selecting the one that's gonna
be best for you. When it comes to picking a clinical trial, it's a real art. You're
going to want to network, find out thing through word-of-mouth, and then after you have selected
a potential trial you're going to want to talk to your physician about the pros and
cons of that agent in that situation.
Different factors that you're going to want to consider are things like, "Is it convenient?"
Is it in this part of the country? Is it a randomized trial? Where you may end up getting
a placebo. Is it a phase 1 trial? Where they may be starting off with such small doses
that you're really unlikely to get a benefit. So how do you find out these things? Well,
it's usually word-of-mouth, again. Talking to the clinical trial coordinators. It's surprising
how candid people will be with you on the phone because they're trying to find candidates
for these trials. Successful university centers or private centers that are doing clinical
trials usually have an assigned person that is the custodian of the trial and is trying
to find new patients and make sure the patients get matched to the right trial and it's important
to find that person and there's usually a name attached when you go online and a contact
person. You can build relationships with these different clinical trial coordinators and
find out how these trials are evolving. How have people been responding? It's a lot of
work and thing is not going to be generally available through your physician who doesn't
have time to keep up with all this stuff.
You also need to be aware of the fact that this is a big business. There are a number
of centers that have built a reputation, MD Anderson, for example, on having massive amounts
of clinical trials, but their job is to find patients for the trials. They're not necessarily
interested in matching the patient with the best agent, and I don't mean that in a disrespectful
way, but when you have large financial incentives to accrue large numbers of patients, then
you're going to be very hungry to find people to fit, and slot them in as quickly as you
can. So there is going to be a need on your part to be aware of the fact that there are
other incentives behind the scene besides simply finding you the best therapy.
So we're not going to go into all the new agents, but I will give you one example of
a clinical trial that's making a big difference now at the time of this video shoot, and that
is a medicine called Lutetium-177. The sequence started outside the country in Germany and
Australia, and this is an injectable form of a radioactive substance that targets cancer
cells, prostate cancer cells, wherever they may be in the body. Men that are going on
this medicine that's not FDA approved yet and is available on clinical trials now in
the United States are getting very good responses—declines in PSA, reduction in pain—even when all
their other options had seemed to have run out. So there is definitely an upside to finding
an effective agent and it may take a lot of research to find the right one for you. Be
prepared in advance. Don't go and wait until all your options are running out and then
scurry around. Start studying early, become an expert in talking and understanding these
different trials, and then you'll be able to extract the maximum benefit from an industry
that is growing very quickly.