What I learned from today's conference call...

[tallguy2]

This is the third year that I've listened to the CancerCare Workshop for patients called "Highlights of the ASCO (American Society of Clinical Oncology) 2019 Annual Meeting."

The good news for participants on this forum is that there was nothing that I hadn't already heard about here. Thanks to all the men who diligently follow the latest research and keep us informed.

My take-aways:

1. In most cases a combination of therapies is desirable, as opposed to ADT alone. This means combining ADT with androgen receptor signaling inhibitors such as Xtandi or Zytiga to try to control metastatic PCa. Which to choose? Depends on tolerance of the most common side effects. With Xtandi this drug crosses the blood-brain barrier so there's an increased risk of falls, seizures.With Zytiga it's generally thyroid inflammation and rashes.

2. The latest focus is on men newly diagnosed with metastatic disease and >4 mets to the bone. The latest addition in the arsenal is apalutamide, a "second generation Xtandi." it is used in combination with ADT.

Q: "How to know what's right for me?" It's all about the patient's overall health, the other conditions he's dealing with, and tolerance to side effects. The decision has to also include "risk vs benefits."

3. What if everything is going well and there's no evidence of bone disease via imaging, and ADT is no longer working? This is called "M0." It's hard to catch this stage because usually by the time imaging is ordered bone mets are observed. So a small group of men fit this category. Already approved: enzalutamide and apalutamide. New this year: darolutamide, an androgen receptor signaling inhibitor. Very positive results are being seen, better tolerated side effects, and a good safety profile. So, how to decide what to do? "All these drugs are really comparable...look at the side effect profiles of the drugs to help decide what's right for you."

4. Finally, immunotherapy continues to be of great interest, especially: CAR-T cells and checkpoint inhibitors that can benefit certain patients with genetic alterations. "Ask your doctor to check the tumor for genetic alterations to determine if you are a candidate for currently available drugs or newer PARP inhibitors."

This session was recorded and should be available soon. I hope that Darryl will post the website for us. The PCa section lasts about 10 minutes and starts at about 45 minutes into the call.

[henukit]

Thanks for the update, greatly appreciated!

[NPfisherman]

Thanks for posting...As I always say, "The Science is Coming !!!"..... like Secretariat on the home stretch..

Don Pescaado

[tallguy2 in reply to NPfisherman]

You’re welcome. I was a little surprised that this highlights talk didn’t cover some of the latest imaging in clinical trials today, nor did it cover the newest radiology treatments being studied. Still, a good summary for the 10 minutes that Dr. Sloan had for this presentation.

[StayingOptimistic in reply to tallguy2]

Thanks very much for posting

[Grumpyswife]

Maybe you can clarify paragraph 3. Are they saying that if one has only soft tissue mets and no bone mets they would be qualified for apalutamide?

I am interested in their distinction between bone mets and soft tissue mets (say lung) and giving that an M0 designation.

Thanks.

[tallguy2 in reply to Grumpyswife]

Yes, I think that's right. Xtandi, Erleada, Zytiga, and now Nubeqa (just FDA approved in 7/2019) are the 4 2nd-generation, FDA-approved anti-androgens for "non-metastatic" patients who see their PSA begin to rise despite being on ADT. That is, nmCRPCa.