ASCO commentary and update no. 4

There were about 50 prostate cancer-specific posters presented in the general poster session on Sunday, and we will give a quick overview of some of the more interesting ones.

Two posters provided early data on neoadjuvant chemotherapy prior to radical prostatectomy as a strategy to manage patients diagnosed with high-risk prostate cancer. Neitherof these posters discussed the effectiveness of the strategy — only its feasibility and safety so far. However, Garzotto et al. reported on the neoadjuvant use of docetaxel and mitoxantrone (abstract 5121)and Sonpavde et al. explored the potential of bortezimib in the same setting (abstract 5127). By contrast, Wu et al. (abstract 5122) reported on the feasibility of paclitaxel therapy before external beam radiation therapy (whether or not the patient had received a prior radical prostatectomy). In all cases it appears that these strategies are feasible. Whether they are effective in lowering risk for progression over time will require larger studies with longer-term follow-up.

Armstrong et al. (abstract 5137) have used data from the TAX327 clinical trial to develop and internally validate three risk groups into which it is possible to classify men with castration-resistant prostate cancer (CRPC). These risk groups may be useful in future clinical trial design — but they still next external validation before such a use is reasonable.

The stream of data regarding new drugs and drugs approved for other uses but now being explored in prostate cancer continued, with additional data on dasatinib (Sprycel), sunitinib (Sutent), sorafenib (Nexavar), satraplatin, ipilimumab, patupilone, picoplatin, cediranib (AZD2171), CNTO328, IMC A12, inecalcitol, nab-paclitaxel, lenalidomide, RAD001, and others. Most of these data suggested that trials of these drugs could and should be continued, but there was no immediate sign of any “breakthrough” implying that one or more of these drugs would have major survival impact.

Phase II data do suggest that weekly therapy with MER-101 (Orazol) — an oral formulation of zoledronic acid — may be equivalent or perhaps even more effective than monthly injections of zolendronate (Zometa) in managing bone loss in men treated with long-term hormone therapy (abstract 5161). However, these data need to be confirmed in at least one Phase III clinical trial, and the expected approvals of toremifene and denusomab may, in any case, change the standard of care for prevention of bone loss and fractures in such patients.

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