"Discussion on CHAARTED, LATITUDE and STAMPEDE Trials"

[pjoshea13]

Not a discussion, but three separate presentations.

Easier to follow for those who are already familiar with the trials & published papers.

-Patrick

urotoday.com/video-lectures...

[Dan59]

Patrick, thank you for this great overview.

[Dr_WHO]

Is there someway we could put this in a special place where it will be available for people to review, not just on this post? It seems like about twice a week there is a post where people would benefit from it.

[Hidden]

Thanks. I now know of an oncologist in the Phoenix area.

[Flash64]

Thanks for this!

[rococo]

Excellen% find . will save and review this info. Always a problem when to initiate these new drugs when the studies were for crpc, now hormoe sensitive but the question Iam asking is why xtandi, zytiga , chemo works best for metastatic than none met Why wouldn't earlier on be even better for long term survival? Thanks Patrick.

[pjoshea13]

Rococo,

An excellent question.

Traditionally, it has been easier to do a trial on men who have exhaused all options. The risk to Pharma is that the drug will not work on that population, but might have worked on earlier stage PCa. The advantage of even modest benefit in CRPC is that the FDA will fast track approval. With a foot in the door, Pharma will then try to prove that the drug is useful at earlier stages.

But how do you demonstrate benefit in the short term? With a 5 year trial, one might show that ADT+drug was effective longer than ADT alone (time to biochemical recurrence.) But what about long-lerm survival? What are the characteristics of the cancer after failing ADT+drug versus ADT alone?

Dr. De Bono touched on this in a video I posted yesterday:

onclive.com/peer-exchange/p...

It's an interesting dilemma. My instinct says that when ADT begins, we should block as many escape pathways as we can. That should lead to a more durable therapy. But what happens afterward? Do we have the tools to manage super-resistant PCa?

Ultimately, I believe, there will be up-front drugs that plug the holes that lead to Zytiga/Xtandi resistance.

-Patrick

[Hidden]

The point I gather from the Stampede discussion is that docetaxel may be the key drug going forward, as the androgen dependant treatments eventually fail.