Chemotherapy & New Investigational Drugs

This summary is from the 2015 Prostate Cancer Conference where in their lecture, Fabio Almeida, MD and Mark Scholz, MD, discussed Chemotherapy & New Investigational Drugs.  Here is the summary:


PROVEN AGENTS FOR LUPRON-RESISTANT:

  • Provenge - Immune therapy
  • Taxotere/Jevtana - Chemo therapy
  • Zytiga/Xtandi - Hormonal therapy
  • Xofigo - Radioactive therapy

XOFIGO (Radium 223) - Patients with Symptomatic Bone Metastases (castrate resistant)

  • For few metastases (five or less), use EBRT
  • Proven agent to use when Lupron (ADT) resistance has started
  • May not have a PSA drop, but can have survival benefit
  • Anemia is potential side effect
  • Only effective in bone (not in organs)
  • Alpharadin - Different kind of Radio Active Agent (Alpha vs Beta).  Travels short/small distance from the metastasis. Higher doses, but less penetration to blood cells in the bone marrow (marrow is better protected/ more intact)
  • Simple to deliver. Injection. 6 cycles. 1x per month for 6 months
  • No radiation safety issues for patient
  • Imaging for tracking is with CT Pet Scan.  CT shows anatomy combined with Sodium Fluoride shows all (Medicare covers, requires registry)

ALSYMPCA -  ALpharadin in SYMptomatic Prostate CAncer:  

  • Phase III Study
  • Started 2008
  • At least two bone metastases
  • No disease in organs
  • 921 Patients
  • 30% decrease in risk of death (improves survival)
  • Primary Endpoint: Overall Survival
  • Several Secondary Endpoints: Bone fracture, Time to Progression of PSA & others….
  • Statistically significant difference in overall survival:  Radium vs Placebo.
  • Multiple ongoing clinical trials in progress

CHEMOTHERAPY:   

  • Different biochemical mechanism
  • Better earlier
  • Insurance available
  • 4 treatments every three weeks
  • Side Effect, low blood count or infection- countered with Neulasta

TAXOTERE (Docetaxel)

JEVTANA (Cabazitaxel) - New/Improved Taxotere

Use when CA is outside of bone (see Xofigo)

When resistance to Hormonal Therapy - Lupron, Xtandi and Zytiga

Potential advantage of early combination therapy -  (Hormone therapy along with Chemotherapy)  

Potential advantage of early treatment - when men are still sensitive to Hormone Therapy

Potential advantage when Jevtana/Taxotere is combined with Carboplatin (Time to  progression, not survival)

Side Effects Exist - But are manageable


Fabio Almeida, MD

Fabio Almeida, MD is Medical Director of Phoenix Molecular Imaging and Southwest PET/CT Institute in Yuma, AZ. Dr. Almeida oversees clinics in Phoenix, Yuma, and Tucson, providing his extensive clinical expertise in PET/CT imaging. He continues his research, focused on applied medical informatics with emphasis on imaging and networking systems, optimization of fusion technology, and volumetric tumor assessment for radiation therapy planning. He actively participates in several oncology and neurologic clinical trials and is the principal investigator for a novel Carbon-11 PET agent for prostate cancer imaging.


A board-certified medical oncologist, Mark C. Scholz, MD, serves as medical director of Prostate Oncology Specialists Inc. in Marina del Rey, CA, a medical practice exclusively focused on prostate cancer. He is also the executive director of the Prostate Cancer Research Institute. He received his medical degree from Creighton University in Omaha, NE. Dr. Scholz completed his Internal Medicine internship and Medical Oncology fellowship at University of Southern California Medical Center.


This presentation summary was derived from the 2015 Prostate Cancer Conference. A DVD recording of the 2015 Conference is available for purchase. Click here to order, or call PCRI at 310-743-2116.

Comment