A multi-disciplinary approach is crucial in achieving a potential major advance in fighting high-risk prostate cancer (PCA), according to experts during the plenary session today as they cautioned that the entry of several drugs should lead to a balanced and well-coordinated implementation amongst prostate cancer specialists.
“Claiming that abiraterone is a drug for urologists, because it is orally available and Cabazitaxel a drug for a medical oncologist because it is (IV) chemotherapy, is wrong,” said Prof. Bertrand Tombal (BE) during his lecture “Beyond the Androgen Receptor.” “This will send us back in time, into the dark age of cancer treatment. The only way to make a wise choice is in a multidisciplinary setting.”
Tombal listed ADT, docetaxel, zoledronic acid, sipeuleucel-T, Cabazitaxel, Denosumab and abiraterone as the latest array of drugs against PCa. He warned however that there are “sources of instability” that may rendered these drugs ineffective in the battle against cancer. He mentioned patients’ heterogeneity and “corporatism,” as potential threats and also costs that may blocked a coordinated approach to the disease.
“Having nine drugs available is a great opportunity and a major advance….but having nine drugs available is also a potential threat for patients if used in a chaotic manner. Encouraging academic trials is the only correct answer to consolidate the wall against prostate cancer,” Tombal said.
Prof. Johann De Bono (UK) spoke on approaches in androgen suppression and provided an update on the relevance of hormones in castration resistant PCa. With Professors Manfred Wirth and Freddie Hamdy as session chairmen, the lectures, debate and case discussion covered optimal treatment issues, risk criteria and prognostic markers in high-risk prostate cancer (Pca). But the assembled experts still differ on finer points such as disease definition demonstrating that the topic remains a challenge particularly in terms of management strategies.
“Definitions differ although the D’Amico classification is widely used, for instance in the German S3 guidance and the EAU 2010 Guideline,” said Wirth who also moderated the debate on risk classification. In his introductory remarks, Wirth added that “generally accepted post-operative definition is also not available.”
Setting the tone for the debate, Wirth queried the panel on pertinent issues such as risk classifications, prognostic markers and treatment options. Henrik Gronberg (SE) gave a concise overview on biomarker research saying that studies are focused on two areas which are before and after ‘radical’ treatment and with the goal to identify both low-risk and high-risk cancers. He added that markers are measured in tumour or blood in the case of high-risk disease. He also noted that DNA/RNA sequencing capacity is increasing and costs are dramatically falling in recent years,
“There are promising new genomic markers or combination of markers but none are in the clinic today, said Gronberg. On the other hand, Martin Spahn (DE), having noted that high risk Pca is a heterogeneous disease, stressed that current clinical data are insufficient for personalised therapy and that there is a need for doctors to address aggressiveness and for researchers to follow-up on markers to predict survival.
Andrew Vickers (USA) spoke on the pitfalls of classifying patients based on stage, grade and PSA, saying that not all patients with high-risk disease recur after treatment. He said that many questions need to be asked such as the limits of p values. “We also need to know if the use of the biomarker will improve clinical outcome,” Vickers added.
By Joel Vega