So, in today's video, I want to talk about Nubeqa. So, this is a new drug that has come
out on the market. We've had a lot of questions about it. People want to know where do they
take it? How do they take it? Does it work? And we get to ask you, so what do you think?
It's an exciting new drug. This is a pill for men who have what they call M0 (hormone
resistance without metastases) category of prostate cancer and the hope is that Nubeqa
will turn out to be less—or have fewer side effects than its competitors which are Xtandi
and Zytiga and Erleada, and it's not easy to accomplish because those other medicines
are actually quite well-tolerated already. So, it'll be interesting to see how it all
plays out. It's just getting started so we don't have all the information in yet, but
it is certainly an important drug as all these—we call them—second-generation hormonal agents
are. They are for men who have been on Lupron for many years and it stopped working and
PSAs are going up, and the concern is that metastases will be appearing in the near future
unless you do something. The pill is taken twice a day and the hope—as I mentioned
before—is that the common side effects of fatigue and sometimes rashes and other issues
will occur less frequently. It is an unproven premise, but we'll find out with experience.
Okay, so what's the mechanism of action, so to speak? Like, how does it actually work
to fight prostate cancer?
So, Lupron blocks testosterone in the testicles and so when you test testosterone levels in
the blood when men are on Lupron, the testosterone levels are very low. And, over a period of
years, prostate cancer cells can actually learn how to make their own testosterone internally
inside the cancer cell. Testosterone inside the cancer cells, they can activate the DNA
that causes replication and growth. So, Nubeqa and these other agents block the switch inside
the cell that testosterone turns on, and so even though there is now testosterone production
inside these cancer cells, the testosterone doesn't reach the switch to be able to turn
on growth and it inhibits or causes cancer cells to regress or die.
So, in the trial results from the Nubeqa material that I was looking at, it said that it delayed
the progression of metastatic activity by 3.3 years. Is that like an average number?
So when these clinical trials, can you explain that to patients? How they develop this number
over time...
It is an average number. They're comparing to the men that got a sugar pill or a placebo
where the average time to the development of metastasis was like a year and a half,
and in the men that got the Nubeqa treatment, it was more like two and a half or three and
a half years. The exciting thing that I like about these medicines is that in the clinical
trials, they allowed men's PSAs to rise all the way up to 10 before they started them
on treatment, and I expect this medicine is gonna work a lot better when men get on the
treatment when the PSA is very low, say, below one. That's been our experience in my practice,
is if these second-generation hormonal agents like Nubeqa, Xtandi, Zytiga, and Erleada are
started when the PSA is down at a lower level like one or less, then the remissions seemed
to last more than just a couple years but quite a bit longer.
So, have you given Nubeqa in the practice so far? I know it's pretty new.
We've had a few people that have started on it. It's not had a long enough track record
for me to really form an opinion, a first-hand opinion. The studies that have been done look
favorable.
And from the couple of people you've put on, the side effects don't have—I know it's
new, but they haven't seemed to be severe at the begnning of anything or...
No, but most of these medicines are well-tolerated. It's only a minority of men that run into
side effect problems with these medicines, so you have to get exposed to a larger group
of people before you get a sense of whether there's any difference or not.
As far as the drug itself goes, how do you see this changing the prostate cancer landscape
because, you know, in previous videos we were talking about what the M0 space is, you know,
non-metastatic castrate-resistant. Do you see this helping prostate cancer patients
kind of benefit from treatments in the future that they would probably get sooner had Nubeqa
not been available?
Well, all the medicines that are effective in making people live longer open up the opportunity
for people to grandfather into as yet undiscovered medicines, and I've seen this a number of
times in practice where people will get a good remission to , say, something like chemotherapy
and then a new medicine like Xofigo gets approved, and then they respond to the Xofigo, and then
at the time that the Xofigo is starting to run out of gas, then something like Zytiga
gets approved, and it's kind of like catching a wave and riding these new discoveries to
longer and longer survival.
That's a really good point because I think that people don't typically think of prostate
cancer as a chronic disease. They kind of have the "get it out" mentality right away.
So, I think realizing that they're going to be benefiting from future medicine and future
research and that anything that's delaying that progression. It's not like after 3.3
years you die and there's no treatments left and there's no clinical trials left, and there's
nothing left. So, I think getting out of that mindset, that's really important, so I'm glad
you brought that up.
Thank you so much for watching this video. We really appreciate it. If you have questions
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