Published on August 18, 2017
How can physicians keep their patients up-to-date about the latest research?Andrew Schorr was joined by leaders in the field of prostate cancer for a roundtable discussion, including Dr. Philip Kantoff from Memorial Sloan Kettering Cancer Center, Dr. Daniel Petrylak from Yale University Cancer Center, Dr. Sumit Subudhi from The University of Texas MD Anderson Cancer Center and Darryl Mitteldorf, Executive Director of Malecare. The panel explains how they educate their patients on emerging treatments in the pipeline for prostate cancer and discuss when and why clinical trials should be considered.
This roundtable discussion is a Patient Empowerment Network program produced by Patient Power. We thank Sanofi Oncology for their support.
Transcript | Working With Your Physician to Understand Your Prostate Cancer Treatment Options
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. Subudhi, you’re our window into the future. Darryl was talking about telling men we can manage this. Hopefully you live with it and not die from it even where it has spread. What do you tell patients when they come to see you now? Obviously you want to know what their situation is, but more generally what do you tell the patient and the family member with what you have to offer and what you think is coming?
One of the things I first try to do is understand what’s important to them and what’simportant for their quality of life and how they define that.
Are they actively working? Are they planning on some big vacation? Because some of the treatment options can be affected by those choices. So that’s one important aspect. I think the other aspect is that we have a tendency to think of prostate cancer as a one-size-fits-all, whereas in cancers such as lung cancer it’s subdivided, not just histologically under a microscope but also with the molecular characterization. And by doing that, you actually start getting more effective treatments with an improved patient selection.
So we try to incorporate both the understanding of the patient’s quality of life and those factors, in addition to trying to better characterize their cancer. Now, as far as the future goes, I tell them that it’s very helpful.
Because the truth is, in metastatic castration-resistant prostate cancer, as of 2004 there was only one drug, docetaxel (Taxotere), that improved survival. And then after 2010 as the group here has alluded to, there have been five new drugs on the market that improve survival in addition to Taxotere. So that’s pretty exciting and a rapid…
…and you’re combining something.
Now we’re starting to have more effective combinations, also moving things up which we hope will delay the existence of castration-resistant prostate cancer and possibly eventually even cure cancers. And then with the onset of exciting immunotherapies, we believe that we are going to, in the future, have a better potential of curing patients with prostate cancer. And I think that’s the most exciting thing.
Darryl, one of the things I’ve thought about for me as a cancer patient and maybe when you counsel others is first of all, do as well as I can now and have good therapies. And if knowing what they’re workingon, maybe have good therapies that are going to be the bridge to what’s next.
Do you talk to people about that as well?
I like that you used the word “bridge.” For our cancer graph mobile app, we call that a bridge to better health. The understanding of patient-reported outcomes is a product of that cancer graph thing, which is important, actually. If I could just answer a different question, the idea that the treatment of the physical issues, bone pain and such, important. But also as patients are doing better and surviving longer with higher quality, new symptoms are coming up, new side effects.
We used to talk about fatigue and anxiety as the big psychological impact of cancer, particularly an older man with prostate cancer. Now we’ve learned in the last two years, research has shown sleep distress is the number one, complaint of men with prostate cancer.
The second complaint that’s voiced in groups is financial toxicity, the ability to balance copays with a legacy for a family or the enjoyment of day-to-day living. People in rural areas where they have to transport themselves to medical centers have a particularly unique stress from financial toxicity. These are new things that need to be fixed as a consequence of prostate cancer treatment.
I sure hope so. I’m on a neural therapy for a blood cancer I have, and I’m on Medicare Part D. And I work, so I don’t qualify for assistance programs, and so I have a heavy copay. I can afford it. I know many people who can’t, and so I worry about that. When you guys think of combining medicines, these breakthrough medicines, it won’t be cheap. So I think we have to work on that.
One thing around fine-tuning the bridge, one of the propositions is you’re fixing something to buy another five years.
There’s a bit of gamification to treatment planning. You do this, so you could live for the next breakthrough and enjoy that and benefit from the next breakthrough. And patients sort of grasp that. They understand that science is progressing, that fine researchers exist, and there’s motivation to do it both from the heart as well as from the desire to do good.
I think they’re very dedicated. Dr. Kantoff, you had a comment?
I just want to say I completely agree. These are the big issues. What we confront as physicians with patients in making decisions about what the next step is, most of these decisions are—I don’t want to overstate this—but are fairly straightforward. They’re decisions of what to do, and we’ll get more sophisticated in dissecting what should be the next step, but those kind of decisions are fairly straightforward.
The complex decisions and the complex discussions are all about what you’re going ahead to. I spend the majority of my time with patients talking about the impact of the cancer on them and the impact of the side effects. So the decision-making process is a small part of the big part, which is how it affects the patient, how the cancer affects the patient, how the treatments affect the patient.
You three gentlemen are researchers, and you’ve developed new drugs. So I want to talk just for a second about clinical trials. People say okay, you’re working on new stuff, is there a chance for me to have a shot at tomorrow’s medicine today? So what would you say to patients about a discussion with their doctor about whether there’s a clinical trial that may match up with them and looking around for that?
Ithink it’s important for the patient to reviewwhat the potential standard therapies are in a given situation. How does that compare to what’s trying to be determined from a clinical trial? And also, what are the known side effects of the drugs that they’re going forth with? I always encourage our patients to undergo treatment with a clinical trial as we’re trying to bring the best science forward. But sometimes it may not be right for them. Sometimes they may feel that a standard treatment is better.
But you’ve got to be cognizant of what you’re trying to accomplish. Are you trying to improve survival, are you trying to improve their quality of life, and what the effects of the drugs are going to be? We don’t necessarily know every side effect, and I think that when a patient decides, they have to talk to their physician about what the science is behind it. Is it supported by good lab data or other patient data? And I think that all of those factors are important to the decision process.
I’m just going to go down the line, first with you, to get sort of final comment. We started with whether you were really pleased with the pace of change, and you all are involved in it. So for our audience there, what do you want to say to a man, a supportive friend or family member who’s out there about where we are now and what’s in it for them, basically now?
I think we have to just look at the progress that’s been made. It’s hard to compare different eras, but 1990s our patients were living only about a year with the most advanced form of prostate cancer. We’ve clearly improved that, and now we’re able to extend survival even further. So I think that there has been real progress made, and with further identification of how a patient may benefit, based upon what about their genetic profile is and what some of the other characteristics are, I think we’re going to make more progress very, very rapidly in the near future.
Dr. Kantoff, what do you say?
I completely agree. I think we’ve seen things accelerate in the past five to 10 years. The pace of change is fantastic. A few years ago, we were talking about sequencing the genome. Now we’re doing it routinely at Memorial Sloan Kettering. Every patient has their tumor sequenced. We know exactly what the vulnerabilities are, and we attack those when they’re applicable. I think the future with immunotherapy is extremely promising. We’ve just touched the surface with immunotherapy across cancer.
I think it will turn out to be a big thing, as is targeted therapies based on molecular profiles. And the two may come together where we understand more about the immune system by understanding the genetics. So I think it’s a great time in the field.
I’ve been in the field for a long time. I’m astounded at how rapidly things are changing at this point.
It gives a great deal of confidence. So, Dr. Subudhi, you wrap up. What would you say to patients and family members and, as Darryl said, people who may be friends or supporters who hopefully would come to them, to their doctor, so that they get what’s right for them? What are the questions they should ask? How do they get at this?
First of all, I think it’s an exciting time to be in the field of prostate cancer just because of the rapid developments and the wonderful and promising drugs that are ahead. What they should be asking is what are the standard therapies, and what are the benefits of getting those standard therapies, and what are the negative side effects or quality-of-life issues that these standard therapies have? Then the next question is, is there a clinical trial that is ideal for me?
There have been patients that have been at my institution that I have sent to actually both of my colleagues’ institutions, because we didn’t have the right trial that fit our patient, and I thought they would be better served elsewhere. But that’s a conversation that needs to be had with the patient and the doctor, but that doctor also has to be open to referring to the right people who are experts in that field.
Okay, I think, Darryl, I’m all about what I call the powerful patient. I know sometimes there’s fear that overlays that, or sometimes as you say people feel all alone. First of all, through Malecare they’re not alone, are they?
That’s right. Through Malecare both in person and online, every man has a new brother. We borrow a line from a TV show about firemen that was available 10 years ago or so:yesterday you didn’t know you had a brother; today you have 10 new ones.
That’s a powerful concept for people to know that it’s not about anyone besides yourself, but there are other people that are like yourself. Around where we are today, five years ago we talked about hope, hope that research comes up with something. Today we talk about opportunity. We’ve transformed hope into opportunity, meaning there are now things you could actually choose to do. It’s not just about—and around choosing what to do. It’s not just about asking questions. It’s also about sharing who you are to your doctor. It’s also about speaking and saying this is what I want, this is who I am. How can you fit who I am?
We’ve heard that from all these three specialists. So I’m really encouraged. I want to thank you all for being with us.
Dan Petrylak from Yale, Dr. Phil Kantoff from Memorial Sloan Kettering, so Connecticut, New York, now let’s go to Houston. Dr. Subudhi from there, Darryl from New York as well and Malecare. I think we could have gotten way into the weeds related to science and names of drugs and this and that, and that’s readily available to you. Malecare has information on it, we do on my site, PatientPower.info through the Patient Empowerment Network, the sponsor of this program. There are some good sources for you.
But I think what comes out of this is an encouraging story, and I’m happy we can do it. Would you all agree, an encouraging story? All right, thank you so much for being with us. I’m Andrew Schorr. Thanks to the Patient Empowerment Network for their sponsorship of this program with support from Sanofi Oncology. Remember, knowledge can be the best medicine of all.