"Novel Hormonal Therapies" Before and... - Advanced Prostate...

Advanced Prostate Cancer
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"Novel Hormonal Therapies" Before and After Chemotherapy

pjoshea13
pjoshea13

New meta-analysis below.

Is it better to have chemo before or after?

"Given the limitations of a meta-analysis of data from the literature, the results show that progression-free survival is always higher when NHTs are administered prechemotherapy in comparison with postchemotherapy. This benefit, however, translates in a reduction of risk of death only in patients with GS ≥8. In the other patients, the risk of death decreases when NHTs are administered postchemotherapy."

-Patrick

ncbi.nlm.nih.gov/pubmed/306...

Cancer Biother Radiopharm. 2019 Jan 8. doi: 10.1089/cbr.2018.2702. [Epub ahead of print]

Influence of Age and the Gleason Score in the Choice of Novel Hormonal Therapies Before and After Chemotherapy.

Roviello G1, Corona SP2, Aieta M3, Roudi R4.

Author information

1

1 Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Vulture, Italy.

2

2 Radiation Oncology Department, Peter MacCallum Cancer Centre, East Bentleigh, Victoria, Australia.

3

3 Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy.

4

4 Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran.

Abstract

BACKGROUND:

Novel hormonal therapies (NHTs) have enriched the therapeutic armamentarium available for patients with castration-resistant prostate cancer. However, there is a need for clinical indicators able to drive treatment decisions and timing. The aim of this report is to perform a pooled analysis based on all available literature focused on prediction of efficacy and survival in patients treated with NHTs before and postchemotherapy.

METHODS:

After reviewing the studies included in this work, the efficacy and the survival of NHTs according to age and Gleason score (GS) was focused.

RESULTS:

A total of eight studies were included in the analysis. With regard to age, the survival hazard ratio shows a better outcome, for both elderly and young patients, in postchemotherapy studies. With regard to progression-free survival, the subgroup analysis of pre- and postchemotherapy studies demonstrates the effect of NHTs on the reduction of risk of progression is greater in prechemotherapy studies irrespective of age. With regard to GS, NHTs show higher efficacy when administered postchemotherapy in patients with GS <8, whereas in patients with GS ≥8 NHTs are more effective in the prechemotherapy setting.

CONCLUSION:

Given the limitations of a meta-analysis of data from the literature, the results show that progression-free survival is always higher when NHTs are administered prechemotherapy in comparison with postchemotherapy. This benefit, however, translates in a reduction of risk of death only in patients with GS ≥8. In the other patients, the risk of death decreases when NHTs are administered postchemotherapy.

KEYWORDS:

Gleason score; abiraterone; age; enzalutamide; orteronel

PMID: 30620216 DOI: 10.1089/cbr.2018.2702

8 Replies
oldestnewest

Isn't this completely ass backwards to what the standard protocol is here in North America?

If clinically correct, it kind of determines, that those with Gleason 8,9,10 have a different disease, than those with Gleason 7,6. Wild!!

Nalakrats

riichardd
riichardd
in reply to Nalakrats

Speaking of different diseases, during chemo over 6 rounds. I had one lung nodule grow from 4mm to 48mm while other nodules actually shrunk. I want to know why! They have recently biopsied the large nodule and compared it to the original biopsy material from the the prostrate and announced it looks similar. They haven't done any other testing on it and are happy with the course of action they are on which is to give me xtandi. They are watching my PSA at the moment which isnt reliable because its a low PSA gleason 10 cancer. The most positive thing they have to offer me is a scan in three months time. To me it would make more sense to get some testing done and actually treat whats there with one or more drugs, before things get any worse but I'm stuck with the NHS standard of care which doesn't allow such like unless approved by NICE. I am frustrated and angry but currently looking into other avenues of treatment.

Nalakrats
Nalakrats
in reply to riichardd

Ask for a Chromogranin A blood test to confirm or not, Low PSA aggressive High Gleason, Neuroendrocrine Cancer cells, and for further confirmation there is a 5-HIAA, urine test. Soft Tissue Tumors, are not usually formed from typical, hormone sensitive Pca pathologies. But they can be--but it is not usual.

This then can determine treatment options. Particular Chemo, or immunology drugs, the latest info, is that IL-23, and maybe IL-17 stop Neuroendrocrine growth. These drugs are protein blockers, and used for Psoriasis today---very expensive bio-logicals--like 45,000 a year, and have shown to stop NET in Animal studies. Just like it blocks a protein that allows Psoriasis.

Getting ahead of myself--first thing is the blood test. If not NET cells, then you really have an enigma. Seems perfect for the new DaRT Technology of Alpha Radiation---but only available in Israel now.

Nalakrats

j-o-h-n
j-o-h-n
in reply to Nalakrats

It really must be difficult to type while holding a fishing pole...but heck, you're a Bronx boy and us Bronx boys could do it all....Like playing stick ball while eating soup....those were the days my friend etc.....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 01/10/2019 6:29 PM EST

Nalakrats
Nalakrats
in reply to j-o-h-n

Has to be Grandma's Penicillin, and I could hit it 3 sewers.

Nalakrats

j-o-h-n
j-o-h-n
in reply to Nalakrats

True story... Aaron would get up to hit and his mother would slip a spoon of soup into his mouth between swings... so help me GOD.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 01/10/2019 7:21 PM EST

I do believe that standard treatment would be androgen deprivation therapy (ADT; hormone therapy that blocks testosterone) plus chemotherapy. It worked for me over 14 years ago. Never give the little buggers a chance to survive and rear it’s ugly head. Attack with anything that halts/slows a feeding source and causes cancer cellular apoptosis.

GD

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