The TALK is a series of webinars addessing how parents and kids of every age speak to each other about their health conditions. If you haven’t noticed, this is a topic that rarely get aired in public – AnCan hopes to address that over the next several months.
We started last Tuesday, June 30 with a discussion around prostate cancer, moderated by genitourinary medical oncologist extraordinaire, Dr. Alicia Morgans speaking with panel members that included pairs of father and child from ages 17 to 43. We also welcomed Dr. Ryan Berglund, a urologist at Clevaland Clinic and spokesperson for MENtion It, a men’s health awareness campaign sponsored by his institution. Dr. Berglund had excellent slides and a 2 minute video that we were unable to view due to a SNAFU by our co-presenters, UsTOO. But the magic of modern technology allows us to provide them to you here …. click here – the video is embedded in the 5th of 6 slides. And to watch the whole, outstanding presentation, click on the video above
Editor’s Pick: Long discussion on the impact of sugar, glucose and cancer
Topics Discussed
Sugar, glucose, insulin and PCa; what next after 2nd line anti-androgens fail?; is there a right # of chemo cycles?; taxane based chemo; diabetics and hormone therapy; Gleason 8 with ultra-low PSA; darolutamide; spot radiation; what’s an ‘oncologist’?; should have had a V-8???; IGRT; Truliicity; moving on from your urologist; blood transfusions; more on selecting the next treatment
AnCan is a huge proponent of inclkuding palliative care in your treatment plan and medical team!!
Palliative care is NOT about hospice or end-of-life ….. that is just a sub-set of palliative medicine. At AnCan we prefer to call it Symptom Management, the lingo used by UCSF. That is no coincidence as AnCan has an excellent longstanding relationship with the UCSF service. Dr. B.J. Miller is on our Advisory Board, and Dr.Mike Rabow, the Director of Symptom Management Service at UCSF, is a friend of the family too.
Last Friday, Dr. Rabow gave an excellent webinar on CureTalks titled Redefining Palliative Care – you can listen here. For those living with advanced cancer, auditing this webinar is a MUST in our view!
More good news to offset the difficulties of advanced cancer treatment!
If you have been paying attention, you will have noted that ADT (androgen deprivation therapy) drugs may protect against COVID19. A certain male protein, TMPRSS2, acts as a door handle for the virus to enter the lungs. ADT drugs suppress TMPRSS, and the LHRH antagonist, degarelix (Firmagon) has been shown to be very effective in controlling the virus in an Italian trial and is now being tested here in the US through the VA System; Prostate Cancer Foundation has sponsored both trials. Here are a couple of links to enlighten you:
Now the BBC is reporting this morning that dexamethasone may be a “lifesaving” COVID19 drug. Dexamethasone is a steroid, frequently used around the time of infusion for intravenous infused chemotherapy. In the UK RECOVERY Trial it has been shown to perform as a very effective agent to control the immune system, hence the aggression of the COVID19 virus. AND its inexpensive and readily available!
So if you are anything like our intrepid AnCan Board Chair, Peter Kafka, and currently on ADT and chemo, you may be very well protected against COVID19.
New G4+4 Dx with very low PSA; Tx after Lu177 PSMA fails; immunotherapy with no positive markers vs Jevtana; perineal pain; successful RT to prostate for Mx man; remarkable continued success from abi; interpreting inconsistent scan report; recurrent PCa plateaus w/o treatment; continued success from PARP-I
Chat Log
Jake Hannam (to Everyone): 5:21 PM: Jonathan Epstein 410-955-5043
Len (to Everyone): 6:00 PM: Talabostat is an experimental drug that initiates an inflammatory response in the tumor microenvironment, converting cold tumors to hot tumors and thereby making them better targets for checkpoint inhibitors, like pembro or nivolumab. The open-label Phase 2 basket trial is NCT04171219
scott (to Everyone): 6:01 PM: I have to go. I have an online class tonight. Best to everyone. See you next meeting.
Larry Fish (to Everyone): 6:35 PM: there are a number of variations on the ‘perianal abscess leading to lumps and related painful cysts and common and unusual perianal conditions….you can just Google any of the related terms and get to the articles and links that I ran into in my intermittant condition and still looking for a definitive answer or treatment that relolves it permanently. So I use a ring pillow for my chair and it comes and goes.
I was recently honored to collaborate with WEGO Health for a presentation on how to conduct virtual meetings and support groups. Watch the recording above …. And we also distributed a Moderator Cheat Sheet for Virtual Meetings that you can download.
Please reach out to me at rd@ancan.org or 415 505 0924 if you have questions.
Darolutamide (Nubeqa) plus androgen deprivation therapy (ADT) led to a 31% reduction in the risk of death compared with placebo and ADT in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC), according to results of the final overall survival (OS) analysis of the phase III ARAMIS trial, which were presented during the 2020 ASCO Virtual Scientific Program.
At the primary analysis, the median metastasis-free survival (MFS) was 40.4 months with darolutamide versus 18.4 months with placebo, leading to a 59% reduction in the risk of metastasis or death. Darolutamide had also demonstrated a favorable safety profile, with no increased incidence of most adverse events (AEs) that are associated with the agent, at this time point.
Results also showed that darolutamide significantly delayed time to pain progression, with a median 40.3 months versus 25.4 months with placebo. Nubeqa also delayed the time to first cytotoxic chemotherapy. Dr. Fizazi, however, did note that cardiac arrhythmias, including those of grade 3/4 in severity, were higher with darolutamide (7.3% and 1.8%, respectively) than with placebo (4.3% and 0.7%).
Results from the TheraP Phase 2 trial found that in men with metastatic castration resistant prostate cancer who progressed after treatment with docetaxel, 177Lu-PSMA-617 was more active than cabazitaxel (Jevtana), according to data presented at the 2020 American Society of Clinical Oncology (ASCO) Virtual Scientific Program.
The data also demonstrated that grade 3 or 4 side effects, which are considered serious or severe, were less common in patients who received LuPSMA. PSA-progression-free survival (PSA-PFS) favored LuPSMA as well. The randomized phase II trial included men with mCRPC post docetaxel suitable for cabazitaxel, progressive disease with rising PSA and PSA ≥ 20 ng/mL. Prior to admission to the trial, Imaging with PSMA radiotracers had to confirm that the patients’ tumors had high PSMA-expression to be eligible.
The PSA response rate was higher in patients who received LuPSMA than those who received cabazitaxel (66% vs 37%; P< 0.001). This represented a 29%, (P< 0.0001) absolute greater PSA response rate in participants receiving LuPSMA compared to cabazitaxel.
Editor’s Pick: Why are there no new chemotherapy treatments for prostate cancer?
Topics Discussed
Using Procrit; docitaxel + carboplatin study; chemotherapy issues; bone density scans; itchy skin; cramping; chemo cycles vs rounds; pre-chemo advice; why no new chemo treatments?;genetic vs somatic gene testing; Covid19 impact on advanced treatment; scanning for recurrence – sensitivity; ROS1 mutation; liquid vs solid Bx analysis; are metastatic PCa cells homogenous; rectal pain post RT
Here is more evidence to support AnCan’s position that it is benficial to add palliative care to your medical team early for those diagnosed with T3/T4/advanced cancer.
While we question the validity of the statistical results based on the large drop-out rate that likely selects for lower overall survival, there is no question in our minds that palliative care is very helpful in manging treatment symptoms and side effects.
Onward & upwards …. rd
Participants in Early-Phase Clinical Trials Need Better Palliative Care Integration
Patients participating in phase 1 clinical trials could benefit from the integration of palliative care, according to data presented at the 2020 ASCO Virtual Scientific Meeting.
BY BRIELLE BENYON
PUBLISHED JUNE 05, 2020
Palliative care is an integral part of a cancer treatment plan and should not be dismissed for patients who are participating in clinical trials. In fact, data presented at the 2020 ASCO Virtual Scientific Meeting showed that patients participating in phase 1 clinical trials tended to have improved quality of life (QOL) outcomes when they received palliative care.
“We all know that ASCO now recommends concurrent palliative care by a palliative care team within eight weeks of diagnosis based on multiple randomized trials showing improved symptoms, improved quality of life, less depression and anxiety, despite increased prognostic awareness,” Dr. Thomas J. Smith, professor of oncology at Johns Hopkins Medicine, said during a pre-recorded presentation of the research.
A total of 209 patients at Johns Hopkins Sidney Kimmel Cancer Center and City of Hope received a palliative care intervention, which included two nurse-led visits to discuss physical, psychological, social, and spiritual issues, as well as advance directives. There was then an interdisciplinary team meeting to discuss each patient and make recommendations. There was also a single goals of care (GOC) discussion.
These patients were then compared to the control arm, consisting of 218 patients. However, by the end of the study, there were 112 patients who completed the intervention arm and 113 patients in the control arm. Others either withdrew or refused, were too ill to complete the study, died, or were lost to follow-up.
“In fact, the mean overall survival was 8.1 months. So that fits appropriately with palliative care and advanced medical directives,” Smith said.
The initial distress thermometer score was 3.6, “where most authorities recommend that 3 is a cutoff for an intervention,” according to Smith.
Patients provided with palliative care showed less psychological distress (average score of 1.9 in the intervention arm, vs. 1.2 in control). Though not statistically significant, the palliative care group also had a trend toward improved QOL (3.7 vs. 1.6).
Participants had high rates of symptom-management admissions (41.3%) and low rates of advance directive completion (39%). A total of 30.7% of patients used supportive care services, including hospice. There was no clinically significant change in patient satisfaction with oncology care providers, which was already high at baseline.
Ultimately, the researchers concluded that there is a need for better integration of palliative care for patients participating in phase 1 clinical trials, especially as patients move from treatment to supportive care at the end of their lives.
“Remember to always ask about symptoms and advanced medical directives, even in phase I patients because they will have symptoms,” Smith said. “And most of them want to have a discussion with (oncologists) about advanced medical directives.”
