David I. Quinn, MD: Prostate Cancer Update ESMO 2012

The Group Room at the 2012 European Society for Medical Oncology (ESMO) Congress in Vienna was made possible, in part, by:

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VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International

This is Selma Schimmel for The Group Room at the ESMO 2012 Congress happening now in Vienna where we’re joined by Dr. David Quinn, who is the Medical Director of the USC Norris Cancer Hospitals and Clinics.  He is the Leader of the Developmental Therapeutics Program at the Head of the section of Genitourinary Medical Oncology, and Associate Professor of Medicine in the Division of Cancer Medicine and Blood Diseases at the Keck School of Medicine at The University of Southern California.   We’d like to get an update from you on prostate cancer and anything else that’s really struck you at this meeting.

David I Quinn, MD:  Medical Director, USC Norris Cancer Hospital, Los Angeles

We’re at an interesting time in prostate cancer.  We have a whole series of new therapeutics that have come and are about to make a big difference.  We see now extended survival for those people that got involved in the trials.  And even those that didn’t get the drugs on the placebo-controlled trials have done better than expected.  From that perspective, we have abiraterone well into the market and available and enzalutamide just approved in the last few weeks and, radium-223 at the FDA.  Enzalutamide is now licensed and radium-223, a new therapeutic, is on the way with the FDA and I think we will probably see it on the market in the U.S. in 2013, perhaps later in the year.  At this meeting, I think we’ve seen some more data on all of these therapies.  We’ve had updated presentations of what are generally called secondary endpoints.  These are important for patients because they answer a question that is not necessary the primary interest of the FDA.  The FDA and prostate cancer wants to know, if you give therapy X to the patient, do they live longer and therefore, is it worthwhile and that’s usually the metric we use in prostate cancer.  All of these things prolong survival.  As we proved before with chemotherapy and also with immunotherapy, so what we’re getting now are reports on the quality of life aspects, relief of pain.  The good news is that these agents are effective relievers of pain, and improved quality of life and performance status very significantly.  The hormonal agents such as abiraterone and enzalutamide, we saw further data yesterday that they delay or prevent pain.  The biggest palliative impact we have is probably with radium-223 which produces major analgesia, gets a very large number of people off opioid narcotics, so-called analgesics and I think represents a significant advance.  So what we’ve seen presented here at ESMO is some detailed drill-down on what’s going on with these therapies and that will give the patients a better of idea of what to expect which is generally good.  Unfortunately, not everyone responds and working that out is now our task.  We’ve had some interesting presentations that have been negative, so we’re still looking for something to get married to dose attacks with chemotherapy in prostate cancer.  A number of physicians have said to me, well, why do you need to give chemotherapy anymore?  I think the important point here is that even with all these other therapies; there is still a role for chemotherapy at the right point and making that decision is going to be an art that hopefully evolves into a science.  We are still going to need to give chemotherapy to patients who have metastatic castration-resistant prostate cancer.   We had a negative study presented yesterday with Revlimid (lenalidomide) and docetaxel which was a fascinating study – 1,000 patients.  And one would have predicted that it should have been positive.  It’s a drug that has activity in other cancers, particularly myeloma and so from that perspective, I’m a little surprised to see that negative.                

Selma Schimmel, Founder & CEO, Vital Options International

Dr. David Quinn, Medical Director of the USC Norris Cancer Hospitals and Clinics, Leader of the Developmental Therapeutics Program for the USC Norris Cancer Hospitals and Clinics, Head of the section of Genitourinary Medical Oncology Unit, and Associate Professor of Medicine in the Division of Cancer Medicine and Blood Diseases at the Keck School of Medicine at The University of Southern California.

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