Video Discussion of ASCO Highlights.

[pjoshea13]

"Dr Neal Shore (Carolina Urologic Research Center, South Carolina, USA), Dr Joaquin Mateo (Vall d'Hebron Institute of Oncology, Barcelona, Spain) and Dr Karim Fizazi (Institut Gustave Roussy, Paris, France) discuss the treatment and management of metastatic castration resistant prostate cancer (mCRPC)."

Shore recaps the treatment availability history, starting from 2004 when I was diagnosed. Quite dismal back then, which explains why I felt empowered to go my own way. Quite different today. Many options, although mCRPC is still the fate of many with metastatic disease, & remains difficult to manage.

"Dr Shore provides and overview of the current treatment landscape for mCRPC before Dr Mateo summarises the TOPARP-A study and results of the TOPARP-B study presented at ASCO 2019. The panel then go on to discuss ongoing trials including PROFOUND and TRITON3 as well as summarising the ARAMIS and VISION studies.

"The session concludes with Dr Mateo offering advice on how to manage patients on PARP inhibitors and the associated adverse event profile of this class of drugs."

ecancer.org/video/7975/meta...

& here is more on PARP inhibitors, & also, genetic testing:

ecancer.org/video/7976/gene...

"Dr Neal Shore (Carolina Urologic Research Center, South Carolina, USA) and Dr Joaquin Mateo (Vall d'Hebron Institute of Oncology, Barcelona, Spain) provide an overview on the history and mechanisms of action of PARP inhibitors. They discuss the relevance of defects within the DNA damage repair (DDR) pathway and introduce the concept of PARP inhibitors for treatment of prostate cancer.

"The experts go on to summarise the difference between germline and somatic mutations and provide insights into the difficulties and considerations when testing for these mutations.

"Dr Shore and Dr Mateo reflect on the importance of genetic testing for families and for the selection of treatment for patients. They address the need for comprehensive genetic profiling to detect future mutations and conclude by offering advice to clinicians on how to obtain samples and what is required from the clinical community who treat patients with prostate cancer."

...

I'm reminded of the old joke, where a doctor tells a patient that he can't cure his cold - "but if it turns into pneunomia, I can cure that."

Dr Mateo mentions that BRCA mutations can "spontaneously" occur. In fact, BRCA mutations can be a response to treatment (& a cause of CRPC), & is much more common with newer more intense AR-axis treatments.

So if germline testing has ruled out inherited BRCA1/2 mutations, somatic testing (of a tumor) might nonetheless reveal BRCA mutations. i.e. PARP inhibitors might benefit a larger percentage of patients than once thought.

However, it can be difficult to do somatic testing on bone mets.

-Patrick

[PhilipSZacarias]

DNA testing of circulating tumor cells (CTCs) might provide the required information re somatic mutations. Cheers, Phil