My heart is heavy. Fifteen years ago a remarkable Research Medical Oncologist who cured me of metastatic prostate cancer, Professor Doctor Robert Amato succumbed to his own cancer this week. His funeral is this morning. I hope that McGovern Medical will hire a professor/researcher to continue a much needed project.
Most recently, he was the Director of Memorial Hermann-The Texas Medical Center, as well as a full Professor and Director of the McGovern (The University of Texas) Oncology Division. One of the world’s leading experts in the treatment of Genitourinary Cancer, Dr. A served as a principal or co-principal investigator fir more than 45 clinical trials and authored over 100 professional publications. He also served on editorial boards and as reviewer for numerous professional publications throughout the world.
I think you are the best person to pay the highest tribute to Dr.Robert Amato on his demise. I remember too our late friend Dan 59 mentioning Dr. Amato in high praise and esteem when he replied to some of your posts back in the past. Although I am very distant, I feel the passing of both as a great loss : one as a great oncologist and the other as a unique friend.
I went into trial within a month of finding mets. I was one of the nine with complete response. Here are two abstracts
Trial of chemotherapy plus hormonal therapy as initial treatment for unresectable or metastatic adenocarcinoma of the prostate
Robert Amato and Haby Henary
DOI: Published May 2005
Proc Amer Assoc Cancer Res, Volume 46, 2005
Abstract
5748
Background: The delivery of chemotherapy in a setting of hormone refractory prostate cancer has shown palliative benefit, with substantial PSA decline, strongly suggesting that disease modifying potential exists. Recently, chemotherapy is being reported to show a survival advantage. The stage is set for chemotherapy to be given earlier in men with prostate cancer. As a working hypothesis, transformation from an androgen-dependent to an androgen-independent phenotype is mediated by the expansion of an androgen-independent clone already present at the time of androgen deprivation. If this model is correct, then it would be desirable to bring treatment to bear on the androgen-independent component when the corresponding tumor burden is minimal. We view the androgen-independent component as analogous to “microscopic residual” or micro-metastatic disease for which adjuvant chemotherapy has shown to be effective in other contexts. Methods: Each course of chemotherapy lasts for 8 weeks (6 on/2 off). Patients were treated on weeks 1, 3, and 5 with adriamycin 20 mg/m2 as a 24-hour intravenous infusion on the first day of every week in combination with ketoconazole 400 mg orally 3 times a day, daily for 7 days. On weeks 2, 4, and 6, treatment consisted of docetaxel 35 mg/m2 intravenously over 1 hour on the first day of every week in combination with estramustine 280 mg orally 3 times a day, daily for 7 days. Hormone therapy, GnRH antagonist, is initiated within the 3 months of initiating chemotherapy. After the completion of 3 courses of chemotherapy, the addition of casodex occurs. Hormone management continues for a total of 24 months. At the completion of 24 months of hormone therapy, then discontinued. Men are then followed every 12 weeks with a serum PSA, including testosterone level. For those men who have a PSA recurrence, hormone therapy will be reinitiated. Results: Nineteen men have been enrolled, to date, with a median age of 63 (range 48-76) years. Fifty percent of the men had no prior local therapy, while the other 50% either failed surgery, radiation therapy, or surgery plus radiation therapy. Fifty-nine percent of the men had Gleason 7, 12%/8, 24%/9, and 5%/10. Thirty-five percent of the men presented with bone metastasis and 50% presented with nodal involvement. The median PSA reduction to date has been 96% with associated nodal and bone scan improvement. Conclusion: Enrollment is ongoing. Further information regarding PSA response with associated radiographic response and toxicity will be presented.
A phase II trial of androgen deprivation therapy (ADT) plus chemotherapy as initial treatment for local failures or advanced prostate cancer.
Amato R1, Stepankiw M, Gonzales P.
Author information
1
Division of Oncology, Department of Internal Medicine, University of Texas Health Science Center at Houston (Medical School)/Memorial Hermann Cancer Center, 6410 Fannin St., Suite 830, Houston, TX 77030, USA. robert.amato@uth.tmc.edu
Abstract
PURPOSE:
Long-term hormonal ablation in prostate cancer is associated with decreased overall health and quality of life. Few reports emphasized the role of chemotherapy in the management of early stage prostate cancer. This study analyzed the safety and efficacy of androgen deprivation therapy (ADT) plus chemotherapy as initial treatment for patients identified as local failures or not eligible for prostatectomy or radiation therapy due to advanced disease presentation.
METHODS:
Enrolled patients received ADT in the form of leuprolide every 12 weeks for 24 months with bicalutamide initiating after the completion of chemotherapy. Chemotherapy consisted of ketoconazole and doxorubicin for weeks 1, 3, and 5 and estramustine and docetaxel and for weeks 2, 4 and 6. During weeks 7 and 8, no treatment was received.
RESULTS:
Forty-six patients were enrolled, and forty-five patients were evaluable. Median progression-free survival (PFS) was 23.4 months. Median overall survival (OS) was 53.7 months. Out of 45 patients with measurable disease, 22 patients had an objective response: 9 patients achieved a complete response; 2 patients achieved a partial response; 10 patients achieved stable disease. Frequent grade 3 adverse events included elevated ALT (17 %), hypokalemia (13 %), and hypophosphatemia (13 %). Grade 4 adverse events were rare and included low bicarbonate (2 %), hypokalemia (2 %), leukocytopenia (2 %), and neutropenia (2 %).
CONCLUSIONS:
The treatment demonstrated clinical benefit in all patient subsets with minimal reversible treatment-related adverse events. Subgroup analysis suggests that having prior local therapy resulted in greater PFS and OS.
Are these all different types of chemo? Have any clinics mimicked this treatment protocol following this clinical trial? Was the success due to the multiple combinations? Chemotherapy consisted of ketoconazole and doxorubicin for weeks 1, 3, and 5 and estramustine and docetaxel and for weeks 2, 4 and 6.
I doesn't seem like this combination is a common treatment protocol these days. Do you know anywhere where they use this combination or something similar?
Yes, I do George. Same place that Dr A did his research when I first met him. The exact same protocol is being used for metastatic breast cancer at Maylor College of Medicine. I learned this from my cousin who is being treated there.
BTW, Dr A told me that prostate cancer and breast cancer are closely related more than most realize.
Anyway there is more dollars raised and spent in metastatic breast cancer research than metastatic prostate cancer. A fact of life.
The President of McGovern Medical School told me when I talked about Sr A’s research and protocol that I need to understand that because Dr A was a world class expert, he had greater flexibility in treatment under the category of clinical research. He said that Dr A’s treatment is best described as ultra standard of care.
The main reason that it is not being picked up are dollars and…. All 8 complete responses had something in common. We all were newly DX’d by rapid PSA rise and a track record of nuclear bone scans and soft tissue CT scans. All most likely with micro-metastasis at original DX for Prostate Cancer. The rest of the group had a more invasiveness metastatic cancer and had different results.
I think about my best friend when his MO in Seattle told him to get his affairs in order as he had about three months to live. Dr A hit him three years before the cancer spread to his brain.
Now my words are biased. I understand that all the new silver arrows work great for palatine care with marked longevity results.
Me? I went for the cure as soon as DXd with Stage 4.
I also understand that there are plenty of quacks out there and the medical community as a whole follows standard of care. We are all different with scope of disease and varying comorbidity issues.
I count God and His Guidance of Dr A’s skills for my 18 years of undetectables; 12 without any treatment at all.
I see my MO on Thursday. A quick lab report: PSA @ 0.04; T @ 1624. In depth labs are next week to see if I am still hormone balanced.
I realize that most of what I write has no bearing today on the bulk of the members. One day…..
My heart is heavy. Fifteen years ago a remarkable Research Medical Oncologist who cured me of metastatic prostate cancer, Professor Doctor Robert Amato succumbed to his own cancer this week. His funeral is this morning. I hope that McGovern Medical will hire a professor/researcher to continue a much needed project.
Most recently, he was the Director of Memorial Hermann-The Texas Medical Center, as well as a full Professor and Director of the McGovern (The University of Texas) Oncology Division. One of the world’s leading experts in the treatment of Genitourinary Cancer, Dr. A served as a principal or co-principal investigator fir more than 45 clinical trials and authored over 100 professional publications. He also served on editorial boards and as reviewer for numerous professional publications throughout the world.
Very impressive man. Sad news about him. The urologist that i first met with at Walter Reed, died about a year ago. Doctors surprising to many, don’t have s long life span average, just like nurses, because they work long hours, loads of stress, and they may not eat healthy or exercise much.
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Another Loss To Prostate Cancer[Don Imus,79]
Would it work when we go back to the old treatment again? Your input would be appreciated.
