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Mitoxantrone and Veliparib in Prostate Cancer: Updates From ASCO 2017

Interview with Tanya B Dorff MD

‘Filmed by PracticeUpdate with permission for inclusion on Uro Onco. More information and additional ASCO coverage can be found at www.practiceupdate.com

Interview transcript

Dr. Farzanna Haffizulla:

Welcome to this PracticeUpdate. I’m Dr. Farzanna Haffizulla. Joining me today is Dr. Tanya Dorff. Dr. Dorff is an Assistant Professor of Clinical Medicine at USC Norris Comprehensive Cancer Center and Hospital at the University of Southern California. Dr. Dorff, great to have you joining us again. 

Dr. Tanya Dorff:

Pleasure to be here.

Dr. Farzanna Haffizulla:

So, I wanted to talk about the presentation that you did with Maha Hussain related to mitoxantrone in the adjuvant setting of high-risk prostate cancer following prostatectomy, a SWOG trial, and several elements of this particular study have previously been presented. What is new in this particular presentation that you’d like to highlight for our viewership?

Dr. Tanya Dorff:

So as you mentioned, the primary endpoint was related to the use of mitoxantrone, but that’s not what’s new in this presentation. This is sort of the final mature data and what it shows is that men with high-risk prostate cancer who receive 2 years of adjuvant androgen deprivation therapy after prostatectomy have markedly better survival than would be predicted. Interestingly, Dr. Hussain shows that 86% of men are alive at 10 years, and of the men who died, 80% of them died of causes other than prostate cancer, suggesting that the adjuvant ADT is really improving cure rates. The other piece of information that is new is about testosterone recovery, so 75% of men did recover testosterone within 12 months of completing treatment and I think that piece of data helps us when we’re counseling patients about the pros and cons of adjuvant ADT.

Dr. Farzanna Haffizulla:

Absolutely. Now Dr. Hussain also presented some meeting at this year’s ASCO related to the PARP inhibitor veliparib in prostate cancer. Can you tell us about this randomized phase 2 trial?

Dr. Tanya Dorff:

Yes. So this is again a study that’s already had some presentation of the data. The primary endpoint, which was that men with ETS fusion in their prostate cancer would be more likely to respond to a PARP inhibitor added to abiraterone and that was negative. What we’re seeing in this meeting is very interesting data about DNA repair deficiency. Men with prostate cancer that has ATM or BRAC or one of those DNA repair deficiencies had a double response to abiraterone regardless of the PARP inhibitor, so kind of an unexpected and provocative finding.

Dr. Farzanna Haffizulla:

So, what do you think might be some other implications for therapy knowing this information?

Dr. Tanya Dorff:

PARP inhibitors are undoubtedly one of the most exciting therapies in development for prostate cancer, and learning about DNA repair deficiency is really going to guide the development of these agents, but what I would encourage oncologists to do is to consider referring patients for trials of these agents earlier. There are going to be head-to-head comparisons, PARP versus abiraterone or enzalutamide, and if we think of novel therapies as the last treatment after all standard options have been exhausted, then we’re undoubtedly going to fail to find the maximum benefit of how to use these agents.

Dr. Farzanna Haffizulla:

It’s very vital information to highlight for our viewership and we want to thank you again for coming here to PracticeUpdate and presenting and sharing your expertise.

Dr. Tanya Dorff:

Thank you.

Dr. Farzanna Haffizulla:

To our viewers, thank you very much for joining us with this PracticeUpdate. Join us again soon. I’m Dr. Farzanna Haffizulla.

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