EAU 2017: 4th ESO Prostate Cancer Observatory: The Medical Oncologist’s Perspective
Dr. De Santis highlighted that the updated EAU-ESTRO-SIOG guidelines give Grade A evidence for treating patients with metastatic hormone naïve prostate cancer (ie. at presentation) with androgen deprivation therapy (ADT) plus docetaxel, if they are fit enough to receive chemotherapy.1 Furthermore, we eagerly await reporting of (i) the abiraterone arm (Arm G) of the STAMPEDE trial at the upcoming ASCO 2017 meeting in Chicago, IL, and (ii) the LATITUDE phase III trial of abiraterone in patients with newly diagnosed metastatic prostate cancer (ADT + placebo vs ADT + abiraterone + prednisone).
There are also exciting developments in the setting of personalized medicine and metastatic prostate cancer. Among 50 men with metastatic castration resistant prostate cancer (mCRCP) after 1-2 regimens of chemotherapy, 16 patients had DNA alterations, including BRCA 1/2 and ATM. Among these 16 men, 14 had a response to the PARP-1 inhibitor olaparib including all 7 patients with BRCA2 loss and 4 of 5 patients with ATM aberrations.2 Dr. De Santis notes that this report lead to breakthrough therapy designation for BRCA 1/2 or ATM gene mutated mCRPC after docetaxel and hormone therapy.
Finally, with regards to immunotherapy advances in men with prostate cancer, Dr. De Santis highlighted that there is early evidence of anti-PD-1 activity in enzalutamide-resistant prostate cancer patients, specifically for patients treated with pembrolizumab. There are a number of exciting advances coming in the next 12 months according to Dr. De Santis including (i) the addition of abiraterone and prednisolone as standard of care for men with metastatic hormone sensitive prostate cancer, (ii) continued advancement in the arena of personalized medicine, and (iii) although early, continued exciting studies regarding immunotherapy.
1. Cornford P, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur Urol 2017;71(4):630-642.
2. Mateo J, Carreira S, Sandhu S, et al. DNA-Repair Defects and Olaparib in Metastatic Prostate Cancer. N Engl J Med 2015;373(18):1697-1708.
Presented by: Maria De Santis, University of Warwick, Coventry, UK
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
Twitter: @zklaassen_md
at the #EAU17 -March 24-28, 2017- London, England