Paper co-author, Dr. Alicia Morgans, MedPage interview about the findings: (Dr. Morgans is a regular contributor at the fine URO Today website (urotoday.com/center-of-exce...
Alicia Morgans, MD, on Treatment Options for Metastatic Castration-Sensitive Prostate Cancer
An Embarrassment of Riches in First-Line Treatment of Metastatic Hormone-Sensitive Prostate Cancer: Single-agent androgen-deprivation therapy no longer the standard of care
When one considers that for over half a century there was only Lupron, and since 2012, we have seen the addition of newer hormonal agents--Abiraterone, Enzalutamide, Apalutamide, Daralutamide, multiple radiopharmaceuticals, PARP inhibitors, CheckPoint inhibitors, Provenge, and so many things in development ...
The Golden Age of Cancer Treatment is coming...because.... The Science is Coming !!!!
Yes, It seems PCa is catching up with similar developments for my first cancer, CLL. When I was diagnosed in 2006, the infusion drug combo CHOP was the frontline treatment for most patients. Then rituximab was introduced and R-CHOP took center stage. No treatments then were even remotely considered curative, so the goal was the same as in PCa today: to extend the life of the patient. (As with PCa, side effects were secondary issues.)
The only potentially curative CLL treatment back then was a stem-cell transplant. Since there was a 25% risk of death and were VERY expensive, they were usually only considered for very young patients and those whose other treatment options had been exhausted. During my post-RALP IMRT treatments I got to know a CLL patient in the later group. He went through exhaustive preparatory treatments to condition him for the transplant and a lengthy search for a compatible donor. Unfortunately, he died several months after the transplant, as his wiped-out immune system was unable to fight off an infection.
With the advent of BTK inhibitors, ibrutinib being the first, the frontline treatment for CLL has completely changed, with some patients achieving long-term durable remissions that approach being ouright cures. All of the new drugs are oral drugs, so patients no longer need the regular visits to the infusion center. (For Medicare patients there is a cost factor to oral meds that is a topic for another post and another day. It is also worth noting that these newer drugs are not without their own set of side effects.) And as you have commented before, the current immunotherapy drugs have proven much more effective in the systemic blood disorders than in the solid tumor cancers. There is also a small, but growing community of outright CLL cures from CAR-T therapy.
As you say, the better PCa news is that the drug development pipeline is fully loaded with promising agents that may one day free future PCa patients from the debilitating effects of ADT. Having been off ADT now for close to three years, it is the thing I most wish for all my PCa Brothers. Normal T, zero hot flashes, and normal metabolism with no fatigue is a very good thing. As the old Joni Mitchell song so adequately states, ". . . you don't know what you've got 'til it's gone?" is as true in patient experiences as it is in many other aspect of life.
Keep the science coming, NP & Stay Well - Captain K9
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