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Hormonal Therapy for Advanced Prostate Cancer: An Update

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Published on September 1, 2016

Are there recent advances in treating advanced prostate cancer patients with hormonal therapy? Listen as a panel of experts, including Dr. Tomasz Beer, Dr. Russell Szmulewitz, Dr. Emmanuel Antonarakis, and patient advocate Joel Nowak, discusses developments from the American Society of Clinical Oncology (ASCO) meeting.

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Transcript | Hormonal Therapy for Advanced Prostate Cancer: An Update

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Dr. Beer:

Now, an area that we heard less about at this meeting than maybe a year or two ago are hormonal agents. 

A couple of years ago, enzalutamide (Xtandi) and abiraterone (Zytiga) were really at front and center at the meeting and have now become standards of care for men with metastatic disease. But there was one study, Russ, out of MD Anderson that looked at preoperative use of these agents and showed that combining everything, standard hormonal therapy, abiraterone, enzalutamide, didn’t really seem to add to just abiraterone and standard hormonal therapy. Is that a bit of a cautionary note that we shouldn’t assumethat more is always better? What do you think?

Dr. Szmulewitz:

It’s a great question. I think that kitchen sink approach is sort of our instinct. If one thing is good and two things are good independently, then we should put them all together, and that will achieve the best result. I think the only way that we can know that is through studies like this one in which patients were given before surgery different combinations, or given all three or just two. And it didn’t show that the addition of enzalutamide to abiraterone was beneficial. 

And I think that some of this, we have to think about the biology a little bit more and we have to think of how the cancer cell is going to adapt to the therapy that we’re giving it. And so abiraterone, for example, eliminates the production of hormones in the tumor and in the body, and enzalutamide blocks the hormone receptor. The end result of both is to stop the hormones from working.

What this tells us, at least in a short period of time, that perhaps the adaptation isn’t necessarily to, for example, keep the hormone receptor active without the normal amounts of hormones there. I think what this study will also provide is a lot of material to study from these patients so we can try to figure out were the tumors adapting, and how can we, for the next study, refine on that knowledge. 

Dr. Beer:                

To me it’s a reminder that we need to stay humble and do the studies. There are many good ideas in oncology, and those of us that have been in the field for some time have seen many great ideas fail. Some great ideas succeed. Some ideas that we thought were mediocre succeed wildly, like Charted. Many of us really didn’t think that chemotherapy would have such a big impact in early disease. But evidence really is king and until we know, we ought to stay humble and make sure that we recognize thatthings don’t always turn out the way we think they might.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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