Metastatic Hormone-Sensitive Prostate Cancer: Is Docetaxel Really Needed? Researchers suggest simpler ADT+ASI as default therapy.

[cujoe]

Metastatic Hormone-Sensitive Prostate Cancer: Is Docetaxel Really Needed? Researchers suggest simpler ADT+ASI as default therapy - MedPage Today, by Jeff Minerd, Contributing Writer, October 6, 2022.

Seems not everyone agrees that up-front chemo is a good idea for mHSPC patients; i.e.:

"Recent clinical trial evidence has shown the benefit of triplet therapy -- androgen-deprivation therapy (ADT), docetaxel, and an androgen signaling inhibitor (ASI) -- in men with metastatic hormone-sensitive prostate cancer. But authors of a "Comments and Controversies" article in the Journal of Clinical Oncology asked whether docetaxel is truly needed, or whether ADT with an ASI might be the best option for most patients, sparing them toxicity."

No clinical trials have compared ADT plus an ASI head-to-head with ADT and docetaxel in these patients. However, recent subgroup and meta-analyses have provided some suggestive evidence, said Francisco Vera-Badillo, MD, of Queen's University in Kingston, Ontario, and Adi Kartolo, MD, of McMaster University in Hamilton, Ontario, who co-authored the article with Ian F. Tannock, MD, PhD, DSc, of Princess Margaret Cancer Centre of the University of Toronto.

In the following interview, Vera-Badillo and Kartolo elaborated on that evidence and discussed the implications."

(See link below for the full interview)

An Alternative to Triplet Therapy for Metastatic Hormone-Sensitive Prostate Cancer

– Francisco Vera-Badillo, MD, and Adi Kartolo, MD, suggest simpler ADT+ASI as default therapy, by Jeff Minerd , Contributing Writer, MedPage Today October 6, 2022

medpagetoday.com/reading-ro...

The full article is here:

Management of Metastatic Hormone-Sensitive Prostate Cancer: Is Docetaxel Needed?

– An ASCO Reading Room selection, October 6, 2022, Adi Kartolo, MD; Ian F. Tannock, MD, PhD, DSc; and Francisco E. Vera Badillo, MD, MSc, Journal of Clinical Oncology

ascopubs.org/doi/10.1200/JC...

And additional comment here:

In Lower-Volume Metastatic Hormone-Sensitive Prostate Cancer, Is Added Docetaxel Needed? – The addition of docetaxel should likely be reserved for patients who may need it the most, by Rajasree Pia Chowdry, MD, MedPage Today, ASCO > Prostate Cancer, October 6, 2022,

medpagetoday.com/reading-ro...

The controversy rages while patients do their job as test mules. Understand the options and choose wisely. Most importantly, Be Safe and Stay Well,

Paz - K9 terror

[GreenStreet]

thanks for posting. A dilemma.

[cujoe in reply to GreenStreet]

GreenSt. - Well, in spite of my somewhat cynical closing comment, the fact we have new drugs that create a treatment dilemma is as least evidence that our options are increasing - and are actually much better than even a few years back. Hope springs eternal for those of us fortunate to be in the good enough medical space to wait for the hoped for better treatments to come.

Staying Positive may be the best medicine around. One day at a time, with each one viewed as a gifted opportunity to be a part of our world. Not so bad, even for us cancer patients.

Stay Well,

Ciao, Capt'n K9

[GreenStreet in reply to cujoe]

well said 👏👏 better to have a dilemma than no option. As you say we have more options now and the prospect of even more to come

[MateoBeach]

You are pointing out very important questions K-9. The gaps in our knowledge is reflected by the gaps in”SOC”. I call it “the raggedy edge of the SOC”. Like looking at the field of knowledge through a picket fence while moving forward. “Test mules” is an interesting metaphor for us. Mules are a cross between a donkey and a horse (that cannot reproduce’. Heard recently: Mules are smarter than a donkey and faster than a horse. Hmmm?

[d3is4me in reply to MateoBeach]

MB Guess I am a 'Test mule' not as fast as a horse but "as stubborn as a mule"

[NPfisherman in reply to MateoBeach]

Pablo,

If only urologists would follow SOC, then the 5 year survival rate would be closer to 60% in PCa. The SOC is ragged indeed. They also refer to smugglers as mules. Now you and the K9 didn't smuggle anything from Arizona, did you??.. LOL... glad you had fun out west.

Dangerous Dave

[cujoe in reply to NPfisherman]

You mean like this?

imdb.com/title/tt7959026/

There is also this promotional message from Big Pharma to our patient community

youtube.com/watch?v=MQVb_Cb...(Not working as expected?)

[NPfisherman in reply to cujoe]

K9 Terror,

Yes, sometimes Big Pharma needs a mule to get them where they need to go. I wonder what they are smuggling.. saw that film with Clint Eastwood, but it will never replace my affection for some of his other films... Thanks for the song and the movie reference and the reply. Entertaining.

DD

[MateoBeach in reply to NPfisherman]

Thanks, Fish. Yes, carried a full pack-load of friendship and gratitude back from the Arizona high desert. Helps balance the load of carrying the burdens of our disease. MB

[cujoe in reply to MateoBeach]

A hearty OZonian "Tar" for making the trip to connect. Expect we will do so again at a location yet to be determined in 2023. In the months to come, remember to think often of us poor souls in the northern latitudes as you relax in the toasty temps South of the Border.

[d3is4me]

Cujoe Thank you for posting, I am low volume MHSPC and have chosen to do doublet only I guess only time will tell?

[NPfisherman in reply to d3is4me]

d3,

Based on your scan showing only 2 Mets, some SBRT may do you some good. Not sure if that is available to you, but worth considering for any oligometastatic patients.

Fish

[Benkaymel]

I hope they're right because the UK NHS does not offer triplet therapy and I will be starting Xtandi on Sunday in addition to the Prostap (ADT) I've been on for 3 months now.

I've looked at the various CT results and did notice that there is not a direct head-to-head between triplet and ADT+ARI. Also, graphs I've seen suggest that ADT+XTandi may have at least as long an OS as ADT+Xtandi+Doce - again, I hope that's true!

[NPfisherman]

K9 on a wanted poster in a NYC office,

This all ties into the APCCC 2022 meeting where a majority of the best PCa specialists voted that triplet therapy was not indicated in low volume disease. The standard should be an ARPI plus ADT for most patients. Marnie posted a video with Declan Murphy regarding delayed use of docetaxel.

Despite all this information, I still see posters on another location advising triplet therapy on low volume disease. Another thing they say is do chemo while you are young or not too old (Is there a limit?) and can tolerate it. Ignoring the side effects of chemo. Horrible advice.

Perhaps, the best PCa specialists looked at Checkmate 650 and made the same realization that I did in regards to chemo and immunotherapy. In Checkmate 650, only 10% of prior chemo patients had a response to immunotherapy versus 25% in chemo naive patients.If immunotherapy is the future of cancer treatment and not taxane chemotherapy, then avoiding taxanes till later, except in high volume disease, just makes sense.

My 2 cents fwiw...

Fish...another most wanted poster person .

[MateoBeach]

thanks for this clarification. Or is it confusion? The more we know. . .

Yet always to be acutely aware of what we do not know.

Yet another mule lost in the desert

[cujoe in reply to MateoBeach]

Then maybe we should put our heads together on a medical GPS device?

[MateoBeach]

Hmmm K-9, a GPS for navigating a desert of incomplete medical information? Must have sat-phone capability to call a friend. Or home. And an SOS button perhaps linking to FPC. 🤔

Another wandering Mule. 🐴

[cujoe in reply to MateoBeach]

That seems a complete spec for the beta version of a device. I'll get my pack of K9 desert design wizards on it pronto . . . or would that be Tonto, Kemosabi?

youtube.com/watch?v=8uvDWme...(Not working as expected?)

Did he say "trusty Scout" or "Dusty Scott"? Could that nearby "pool" be Watson Lake? Only the Shadow knows. (Sorry, wrong hero for this thread.)

youtube.com/watch?v=p9lf76x...(Not working as expected?)

With enough of us PCa mules we could easily start a medical Mule Train.

youtube.com/watch?v=iYsx9ui...(Not working as expected?)

Get along . . . they'll be going 'till they drop . . .

[MateoBeach]

Rollin rollin rollin . . . . Rest is way to the end of my ride. Heeyah. (Middle left out for mercy). We should have desert camo case for that GPS. And a secret compartment for ??