Treatment Arsenal for Prostate Cancer Expands

Andrew Schorr:

Hello and welcome to Patient Power sponsored by the Seattle Cancer Care Alliance.  I'm Andrew Schorr. 

Will men with advanced prostate cancer benefit, live longer if they receive chemotherapy earlier?  That's a big question.  A lot of research is going on.  Some of it is led by a specialist from the Seattle Cancer Care Alliance, Dr. Heather Cheng.  We caught up with her at the big ASCO convention of cancer experts.  Here is Dr. Cheng and our reporter Carol Preston. 

Carol Preston:

Welcome, Dr. Cheng.  So happy to have you here with us.

Dr. Cheng:

Thank you very much. 

Carol Preston:

First of all, lot of big news coming out about prostate cancer at ASCO.  What is the headline for patients?

Dr. Cheng:

I think the most exciting news is that there is evidence that treating patients with chemotherapy early makes a big difference in a subset of patients.  So the results of the ECOG 3508 trial, which is a randomized trial with many cooperative groups, many cancer centers around the country, around the world working together to try to figure out what is the best way to treat men who when they first meet us as medical oncologist already have disease that has spread outside of their prostate. 

So these are men who we wouldn't necessarily recommend surgery or even definitive radiation because it is already a systemic disease, meaning it's gotten outside of the prostate.  It has spread to locations elsewhere, so we want to treat it everywhere it is.  And in the past we've used hormone therapy alone or androgen deprivation therapy as the mainstay of that treatment, but the results from this study have really been dramatic in showing that in the right patient population giving chemotherapy very early on makes an enormous difference. 

And we are—this is very—a huge difference, 17 months for the patients with the greatest amount and most widespread metastases.  So people who had liver metastases, people who had lung metastases, there was a 17 month difference in—if you got—in the arm or in the population that go—that were treated with hormones alone versus the ones that had both hormone plus chemotherapy.

Carol Preston:

A lot of men are reluctant to go anywhere near chemotherapy, so what is your take on that?

Dr. Cheng:

Well, I think that's a really good consideration, and it's still something we'll need to explore on a patient-to-doctor level.  So each physician, each oncologist and each patient is going to need to determine if that's still the right choice.  I think there is strong evidence that there's benefit.  In the past, it's not an option I even present because there was no evidence or data to support it. 

Now there's good data, so now we can have the conversation and say we know what the benefit is, we know what the risk is, let's make a better educated decision, whereas before we didn't know what the benefit was, but the toxicity was clear.  So I think that's—part of the reluctance is not knowing the benefit but knowing that you're going to make somebody feel sicker. 

Carol Preston:

So do you see as a prostate cancer specialist an immediate sea change in the way patients are treated?

Dr. Cheng:

I think for patients who have disease that has spread outside of the prostate that have particularly—I think the evidence was strongest for people who had disease that had spread to the lymph—to the liver, excuse me, and lung, so visceral disease, or who had extensive bone metastases.  Those are the patients that benefited the very most.  That's the 17-month improvement.  The overall was more along the lines of 12 months, which is still really dramatic.  That's a year, a year of difference. 

Carol Preston:

And that's cumulative.  It's not—you know, every patient is going to be different.

Dr. Cheng:

Right.  Exactly.  That's a median, so that's—so 50 percent of those—that population is going to do even better and 50 percent not as well.  But there are many other treatments now today.  I mean, that's the biggest news, but just in the recent years there have been so many new drug therapies available, so sipuleucel-T, cabazitaxel, enzalutamide, abiraterone.  So the toolbox of treatments has really expanded dramatically.  So this is just—adds to the options that we can provide for patients. 

Carol Preston:

Fantastic news, Dr. Heather Cheng from the Seattle Cancer Care Alliance.  And you hear now, for prostate cancer patients and caregivers, there is yet another option to consider in addition to the toolbox of meds, the use of chemotherapy earlier on for longer living and better quality of life. 

On location at ASCO 2014, I'm Carol Preston for Patient Power. 

Andrew Schorr:

Thanks for watching.  We'll continue to keep you posted on the latest treatments and research for advanced prostate cancer. 

I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all.  

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff 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.