Chaarting direction after stampeding along the relevant latitude

So about 3 years after the initial report of the results from the CHAARTED trial, 2 years after the initial report from the ADT + docetaxel arm of the STAMPEDE trial, and 3 months after the reports and publication of data from the LATITUDE trial and the ADT + abiraterone arm of the STAMPEDE trial, people seem to have started to “come to grips” with the implications of the very latest data for both clinical practice and clinical research into the management of newly diagnosed metastatic, hormone-sensitive and metastatic, castration-resistant prostate cancers (mHSPC and mCRPC respectively).

We had discussed some of these issues (see here and here) just days after the presentation of the data from the LATITUDE and the STAMPEDE trials in June, at the annual meeting of the American Society for Clinical Oncology (ASCO), and the simultaneous publication of these data in the New England Journal of Medicine (see here and here). However, two new commentaries on the UroToday web site will be of interest to many of our readers.

The first is an article by Alicia Morgans, MD, entitled “Crashing into progress: new findings meet old habits“. In this article, Dr. Morgans addresses how she is now thinking about the use of ADT along with docetaxel-based chemotherapy or abiraterone, along with a steroid such as prednisone or prednisolone, in the treatment of metastatic prostate cancer — from the moment that it is evident. And she specifically addresses the potential of the PAM50 molecular classifier (developed by Zhao and colleagues at the University of San Francisco and reported on by us earlier this year) which may help us to determine how aggressively individuals may need to be treated.

The second article, by Charles Ryan, MD (“Changes in latitude, changes in attitudes … and DABGA“) is oriented more toward what additional research will be needed to resolve outstanding problems related to the initial treatment of mHSPC and mCRPC, but it also addresses what can and should be done today to best treat patients facing these challenges.

To read these articles, you will need to register on the UroToday web site … but it’s free.

And of course we still sit here waiting for the initial results of the PROSPECT trial of Prostvac VF in the treatment of mCRPC, which could “upset the applecart” all over again if they were to show a similar level of activity as was shown in the original Phase II trial of this form of therapy.

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