An old friend, one of the few who I have not come to know through prostate cancer, recently introduced me to a couple of men who are doing some very interesting work in the realm of social ventures. Between them, they have established several efforts including Wacuri, Generocity, and a mind-body healing program that I ‘sampled’ personally last Friday through a virtual meeting. While we are not yet sure how this initial meeting will develop, I feel certain that you will be hearing more about our joint efforts.
AnCan is a firm believer in the role of complementary medicine …… we often speak about the role of exercise, diet and stress relief in our virtual groups. For those unfamiliar with the term, complementary medicine is used alongside Western medicine with the intention of enhancing treatment. It is not meant to be used instead of Western medicine, and may often include protocols employed frequently in Eastern medicine like acupuncture or reiki. AnCan always recommends that you consult your medical team if you decide to employ a complementary practice.
So, last Monday I went to the lab for my monthly blood test. The results came back confirming what I was already feeling. My long lost twin, Mr. T (Testosterone) had come back. I had not seen “him” in a year or so and it was good to know he was back in action.
I have been on “intermittent” ADT for some 5 years now and this is my third experience recovering some degree of testosterone from the suppressed level of essentially “none”. Each time it has taken some 4 months or so to recover after getting off my drug regimen. It is somewhat of a yo-yo experience in some respects, but I like to think of it today more as the return of the “Prodigal Son”. A time for celebration.
I know that I am fortunate in my disease progression to be able to go on and off androgen deprivation drugs. Many with advanced disease do not have this option. Some might say that I am “playing with fire” or taking a big risk. That might be so, but each of us must take ownership and responsibility for the management of our own journey with prostate cancer, usually working closely with a knowledgeable professional who hopefully “has our back”.
For me this professional happens to be my GU (genitourinary) medical oncologist who closely monitors my “numbers” For some of you it might be your local urologist or GP. And I know for some with low and intermediate grade disease they choose to work with a naturopath or other alternative practitioners. But the bottom line is that there should be someone in a trustworthy position to bounce strategy and concerns off of so that the entire weight of managing our prostate cancer is not solely on our shoulders.
Once again this brings me to the value of our gatherings. Hearing directly from our peers about their first hand experiences is a tremendous reinforcement. We are all no doubt brave sojourners but we are often taking paths that other men have walked before us. Sharing experience is invaluable.
In this post hoc analysis of the SPARTAN trial, there was no significant difference in age-related efficacy rates for apalutamide among patients subdivided into the following three age groups: <65, 65 to <75, and 75 or older. There was, however, significantly more Grade 3/4 toxicity among patients in the oldest subgroup (75+). What I found to be of greater interest, however, was this comment from the author regarding the comparison between enzalutamide and apalutamide: “Apalutamide has been compared with enzalutamide and no significant differences have been observed, although apalutamide has fewer reports of hypertension compared with enzalutamide.”
This study provides initial data on mCRPC patients undergoing therapy with Zytiga (abiraterone/prednisone) and suggests that the efficacy may not be compromised if LHRH therapy (such as Lupron or Firmagon) is discontinued. The primary endpoint of this study was radiographic progression-free survival (rPFS) at 1 year and there was no significant difference between the 2 arms. It was a small study with just 67 patients. To read the full ASCO Conference summary written by Jason Zhu, MD., Duke University, click here: http://tiny.cc/fs9w7y
I’m afraid this is a highly technical blog post, but the “take home message” for you should be that having your Advanced PCa genome sequenced for actionable targets (biomarkers) can do much to inform both you and your oncologist on which treatments are likely to benefit you most and which are likely to fail. At the ASCO Conference, Dr. Isla Garraway, David Geffen School of Medicine, UCLA, led a discussion of several of the talks given at the Conference pertaining to predictive biomarkers. Below are a few highlights. For the full summary of her discussion, click here: https://urlzs.com/ZLFxV
RB1 loss is a poor prognostic sign in mCRPC
Compound loss of PTEN + RB1 and TP53 + RB1 demonstrates significantly worse outcomes to mCRPC treatments compared to single or no ‘hits’
HDSB31(1245C) variant consistently demonstrates value as a prognostic/predictive biomarker, showing ADT-resistance and shorter OS in men with low volume mCSPC
PTEN/TP53 and DNA damage repair alterations are enriched in mCSPC primary tumors
Final results from the CABADOC trial reveal that for 195 men who were randomized to receive either docetaxel followed by cabazataxel or vice versa, as treatment for their mCRPC, more men preferred cabazitaxel based on QoL issues such as fatigue, hair loss and/or pain. There was no difference in efficacy.
A retrospective analysis of 3,065 patients with high-risk localized or locally advanced prostate cancer treated with IMRT in the English National Health Service between 2010 and 2013 was performed. The analysis compared GI and genitourinary (GU) complications for Prostate Only-IMRT versus Prostate + Whole Pelvic Lymph Node-IMRT. Three-year cumulative incidence was 14% for both groups for GI toxicity, and 9% and 8% for GU toxicity, for Prostate+PLN and Prostate-Only RT, respectively. The authors conclude that “Including PLNs in radiation fields for high-risk or locally advanced prostate cancer is not associated with increased GI or GU toxicity at 3 years.”
The Language of Cancer is controversial and here is yet another example in yesterdays CureToday. Mark your calendars for 8 pm EDT on Monday, July 29, 2019 for an AnCan webinar on The Language of Cancer. Our panel will include Howard Wolinsky, cited in this article, and possibly Jane Biehl herself!
This blogger’s personal opinion is simply ‘live and let live’. If certain words motivate some people, recognize they are not intended to offend others and don’t take them personally. Cancer is very personal … surely we should allow each individual living with cancer to use the words that suit them best. And for those not living with cancer, recognize they are not directing their words personally, but generally.
Taking prednisone with abiraterone (Zytiga); debulking the primary tumor for men with mets; CAR-T trials for prostate cancer; APCEDEN – Provenge alternative; PCRI Conference; comparing 2nd line anti-androgen drugs – is one the best?
Some of you may may know already this is ASCO week in Chicago. Prof Bill Burhans, our Board & Advisory Board member is acutely aware since he finds himself back in Roswell Park Hospital with all his docs AWOL! Here at AnCan we are all hoping this is a bit of a false alarm, wish him very well and home soon.
This annual ASCO summer gathering of over 30,000 medics, journalists, advocates and others frequently provides a forum to release important results from clinical trials for all cancers. Prostate cancer is no exception, and we have already seen excellent results from the TITAN trial for the use of apalutamide (Erleada) in metastatic, hormone sensitive disease. In this double blind trial, not only has it outperformed the placebo and now been unblinded, but more importantly there appear to be no statistically significant side effect differences between the two arms. You can read the abstract here.
