A. Oliver Sartor, MD

A. Oliver Sartor, MD, professor of Medicine, medical director of Tulane Cancer Center, and C. E. and Bernadine Laborde Professor of Cancer Research at Tulane University, discusses the design for an observational study (NCT02141438) of disease characteristics and outcome of patients with metastatic castration-resistant prostate cancer (mCRPC) who received 177Lu-PSMA after receiving radium-223.

According to the 2020 American Society of Clinical Oncology (ASCO) Virtual Scientific Program, the outcome was that grade 3/4 hematologic adverse events after treatment with radium-223 were low and treatment with subsequent 177Lu-PSMA seems feasible.

Sartor says that there is a fair group of investigators that have been involved with looking at longer-term follow-up of the use of radium-223 in these patients. There is an extensive database that investigators can use to understand what the ultimate outcomes may be for patients with mCRPC who were treated in selected center involved with a prospective registry.

In addition to outcomes such as secondary cancers and survival, the investigators also collected data for this study in regard to subsequent therapies, according to Sartor. They don’t understand yet if the subsequent therapies were effective or not, but they did look at whether they were used and for how long to get durations of survival. He says the substrate for the study was patients who were on radium-223 at selected practices participating in a prospective registry and were also reporting on subsequent use of 177Lu-PSMA in patients.

<< View more resources and information regarding prostate cancer

Videos

A. Oliver Sartor, MD, discusses the design for an observational study of disease characteristics and outcome of patients with metastatic castration-resistant prostate cancer who received 177Lu-PSMA after receiving radium-223. 

Exploring the Design for Longer Follow-Up of Radium-223 in mCRPC

A. Oliver Sartor, MD, professor of medicine, medical director, Tulane Cancer Center, C. E. and Bernadine Laborde Professor of Cancer Research, discusses the current treatment options for patients with nonmetastatic castration-resistant prostate cancer (CRPC) and what physicians should consider when selecting treatment for their patients.

Three agents are approved for the treatment of nonmetastatic CRPC, which include apalutamide (Erleada), enzalutamide (Xtandi), and darolutamide (Nubeqa). All 3 drugs were tested in clinical trials, which resulted in positive findings that the FDA based their approvals on, says Sartor.

Between these 3 agents, there are some differences in terms of toxicities. However, there are no head-to-head trials to compare these. Sartor recommends considering the cost of the therapy, as well as potential implications for subsequent therapies when selecting 1 of these 3 agents to treat patients with nonmetastatic CRPC. He says we don&rsquo;t know how patients who have been previously treated with these agents should be treated, so further data and analysis are necessary.

A. Oliver Sartor, MD, discusses the current treatment options for patients with nonmetastatic castration-resistant prostate cancer (CRPC) and what physicians should consider when selecting treatment for their patients.

Exploring FDA-Approved Therapies for Nonmetastatic Castration-Resistant Prostate Cancer

A. Oliver Sartor, MD, professor of medicine, medical director, Tulane Cancer Center, C. E. and Bernadine Laborde Professor of Cancer Research, discusses a discrepancy found between conventional imaging and PSMA PET/CT scanning for prostate cancer.&nbsp;

Following FDA approvals for apalutamide (Erleada), enzalutamide (Xtandi), and darolutamide (Nubeqa), further investigation was done to understand what percentage of these patients&nbsp;who received these agents&nbsp;may have PSMA PET/CT scan positivity, says Sartor.&nbsp;

Utilizing patient characteristics from a trial of enzalutamide, this analysis showed that 98% of patients were PET positive, explains Sartor. Moreover, 55%&nbsp;of patients&nbsp;were classified&nbsp;as having metastatic disease,&nbsp;despite being deemed nonmetastatic by conventional imaging.&nbsp;

These findings do not change the metastasis-free survival benefit demonstrated with apalutamide, enzalutamide, and darolutamide, says Sartor. The drugs were investigated using&nbsp;conventional imaging and showed a prostate-specific antigen doubling time of 10 months.

A. Oliver Sartor, MD, discusses a discrepancy found between conventional imaging and PSMA PET/CT scanning for prostate cancer.&nbsp;

Conventional Imaging Versus PSMA PET/CT Scanning in Prostate Cancer

A. Oliver Sartor, MD, Director of the Tulane Cancer Center, discusses the recent progress for the treatment of prostate cancer.

At the 2013 American Society of Clinical Oncology (ASCO) Meeting, Sartor says, there was not much clinical progress in prostate cancer presented, as there was no new positive phase III data.

There was, however, progress on the molecular front. Molecular scientists are getting better at analyzing RNAs, DNAs, and mutations and it is now possible to genomically analyze cancer cells at a single cell level from the bloodstream. This finding is truly remarkable, Sartor says.

In a recent study, it was demonstrated that one cancer cell in a patient and another are not necessarily the same: Heterogeneity extends down to the cellular level. There is still a lot to learn, Sartor insists, as the approach to developing targeted therapies is more difficult than previously thought.

Radium-223 is unique in this regard, in that it can overcome heterogeneity and kill all mutations.

There has been recent progress on the molecular front for the treatment of prostate cancer

It is now possible to genomically analyze single cancer cells

Cancer heterogeneity extends to the cellular level

A. Oliver Sartor, MD | Authors

Articles

Exploring the Design for Longer Follow-Up of Radium-223 in mCRPC

Exploring FDA-Approved Therapies for Nonmetastatic Castration-Resistant Prostate Cancer

Conventional Imaging Versus PSMA PET/CT Scanning in Prostate Cancer

Recent Progress on the Molecular Front for the Treatment of Prostate Cancer