Hey everyone, it's Alex from the PCRI in today's video,
I asked Dr. Scholz to share some major updates that we have from the 2021 ASCO meeting.
ASCO stands for the American Society of Clinical Oncologists,
and those are basically meetings where researchers from all around the world come together—and this
year it was virtual—and share their updates in their research. The reason we're going to be
sharing these studies is because it's going to be really beneficial for our future to see how
the standard of care may change in prostate cancer. It may not be super applicable today,
but it is good to know what's coming down the pipeline. We hope you find this video educational.
A couple interesting things are coming out now in 2021. One is related to men that have metastatic
hormone-sensitive prostate cancer. This is a situation that arises when men
don't get their PSA tested and show up at the doctor's office with some pain in their bones,
PSA is over a hundred, and they've never had treatment and the cancer's already spread.
Studies have shown that these men respond well to a combination of Lupron plus Zytiga,
and the addition of Zytiga to the Lupron has been shown to extend survival compared to
giving Lupron alone then giving the Zytiga later when the Lupron becomes ineffective. Same thing's
been shown if men are treated with Lupron plus Taxotere, a type of chemotherapy, and large
studies again confirmed that the men that have this situation of hormone-sensitive metastatic
disease should be on Lupron and Taxotere from the get-go. Don't wait for the Lupron to stop working
and then start the Taxotere because those people don't live as long. What hasn't
been understood until now—until this recent report—is how will men do if they take Lupron
plus Zytiga plus Taxotere, all three agents. It kind of makes sense to do that because they kill cancer
through different mechanisms, and the combination logically, you would think would extend survival
to a greater degree, and that's what this study confirmed. A study was finally done where half
of the men were treated with a combination of Taxotere and upron and the other half of
the group got Taxotere, Lupron, and Zytiga, all three in combination, and there was a two
and a half year extension in survival in men that got the combination of all three drugs.
So, what logically seemed to be the case has now been proven in a prospective trial,
and the standard of care, in my opinion, now, for men that have metastatic hormone-sensitive
disease, is to go on a combination of all three medicines: Zytiga, Taxotere, and Lupron
when they're diagnosed with this sort of metastatic hormone-sensitive prostate cancer.
Another interesting report coming out of the 2021 ASCO meeting relates to the use of Xofigo
in combination with second-generation hormonal agents like Zytiga and Xtandi. A couple years ago,
it was reported that the combination of Zytiga and Zofigo caused an acceleration in the incidence of
bone fractures, a negative outcome that was rather unexpected, and now we are told as experts not to
combine Zofigo with Zytiga. This is sort of counter-intuitive because, usually, combining
effective agents gives better cancer outcomes, and it is desirable to use things in combination
as long as the side effects are not made worse. So what's interesting about this report from ASCO
is they're looking at a study where they combine Xtandi with Zofigo, Xtandi being a competitor to
Zytiga, a second-generation hormonal therapy, and in this report they showed that if you gave bone
protective agents, like Zometa or denosumab otherwise known as Xgeva, that the incidence
of bone complications was dramatically reduced and almost eliminated. I think that this is an
important report because it is desirable to give agents in combination in men that have
dire types of hormone-resistant prostate cancer, and it's good now to know through this report
that these agents can be combined if preventative agents, protective agents, to prevent the bone
fractures that are known to occur in men that are getting hormone deprivation plus Xofigo. Briefly,
why are these men getting bone fractures? Well, we know already that osteoporosis is accelerated
with all forms of hormonal therapy. Xofigo is a type of radiation that attacks the bones and the
cancer in the bones, so that combination has been shown to exacerbate the risk of hormone-resistant
patients getting these agents and bone fractures, so this is an encouraging report that now we may
be able to give these things in combination, Zofigo and Xtandi and possibly Zytiga as long
as bone protective agents are given at the same time, bone protective agents like Zometa or Xgeva.
Another interesting report from the ASCO meeting relates to the use of high-dose testosterone in
men that are becoming hormone-resistant. This is a very intriguing concept that has been floated
over the last few years as being a rational and possibly effective way to treat prostate cancer.
Men are administered a single injection of testosterone once a month and a certain percentage
of men are having declines in PSA and regression of their cancer. This particular approach
was studied in a report that combined testosterone with an immune medicine called Opdivo. About 40
of the men had significant declines in PSA of averaging about six months remission but some
patients with remissions as long as a year or even more, and the side effects, as you can imagine,
were quite tolerable. Men enjoy getting their testosterone back and the Opdivo medicine has
a known spectrum of side effects. Opdivo has been used for lung cancer and melanoma and other
situations. It's not FDA approved for prostate, and people that are interested in this protocol
may run into difficulty getting it covered by their insurance—it's an expensive drug—but
it's encouraging that this idea of giving testosterone to men with hormone-refractory
disease may indeed be a useful approach and this is just one more study suggesting that
this type of treatment is here to stay, and in combination with other approaches or as
a stand-alone treatment might indeed be a viable way to treat men with hormone-refractory disease.