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Practice Changers in Advanced Prostate Cancer From ASCO 2017: STAMPEDE, LATITUDE vis-à-vis CHAARTED

Interview with Oliver A Sartor 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. Thank you for joining us. Today I have Dr. Oliver Sartor. Dr. Sartor is Laborde Professor in Cancer Research in the Medicine and Urology Departments at Tulane School of Medicine. So wonderful to have you back.

Dr. Oliver A Sartor: 

Glad to be here.

Dr. Farzanna Haffizulla: 

So, I wanted to talk about the most recent data from STAMPEDE. We’re here at ASCO 2017 and I know in STAMPEDE we’re assessing abiraterone in the context of hormone-sensitive prostate cancer. What does this data mean for clinical practice?

Dr. Oliver A Sartor: 

I think it’s practice changing. The utilization of ADT has been ongoing since 1941 and it’s sort of the standard that we’ve become accustomed to. Now, there was a clinical trial called CHAARTED that helped change that standard by adding in chemotherapy and STAMPEDE had another arm that added in chemotherapy. But the new data is with abiraterone, and it’s being compared against conventional ADT, and it’s really strikingly positive, and within the metastatic subset almost a reduction of 40%. It’s like 39% reduction in mortality. It’s pretty reasonably well tolerated.

The PFS and other components of the endpoints were all strikingly positive, and I think it’s a practice changer. I think people are going to be looking at abiraterone with a low-dose prednisone, only 5 mg of prednisone, add it to ADT as being a new potential standard of care.

Dr. Farzanna Haffizulla: 

Well, how does this data differ from LATITUDE?

Dr. Oliver A Sartor: 

Well, the LATITUDE is a little bit more restricted, so what I didn’t tell you about STAMPEDE is it also took the nonmetastatic patients, and I personally feel as though the nonmetastatic patients don’t have adequate maturity to be conclusive. Their failure-free survival is very strongly positive on the abiraterone, but their overall survival and then the hazard ratio was good at 0.75. Confidence level's still big and not a lot of maturity in that. So, STAMPEDE actually took in a lot of the nonmetastatic patients.

LATITUDE did not, so LATITUDE was purely within the metastatic space and they had some restrictions. You had to have at least three lesions or you could end up with a high Gleason 8, a little bit different entry criteria, but the bottom line is, I kind of look at LATITUDE in a way as confirmatory or STAMPEDE as confirmatory. The two really sync together, and together they make a really good story, and the bottom line is that they’re positive, positive, positive for our most important endpoint, overall survival for those with metastatic disease.

Dr. Farzanna Haffizulla: 

Fantastic to hear that. Now, you’ve also reviewed the role of chemotherapy in prostate cancer based on CHAARTED, as you mentioned, and a previous presentation of STAMPEDE but related to docetaxel. What do you think the role of docetaxel is in the face of the data from LATITUDE and STAMPEDE?

Dr. Oliver A Sartor: 

Well, you know, I mentioned that we have a new standard. I didn’t say the new standard.

Dr. Farzanna Haffizulla: 

Exactly, you did.

Dr. Oliver A Sartor: 

So, I chose those words carefully. So, when we looked at docetaxel, they had a strikingly positive, particularly in the high volume subset based on CHAARTED. There had to be four or more lesions, visceral lesions, things that sort of made the disease bad, and it turns out that when you look at these data together I think it tells you that there are two options. I don’t think we have to go with the docetaxel. I don’t think we have to go with the abiraterone.

I think it’s conceivable to say that we’re unsure about which one really might be better. I’ll say that from a side effect perspective, you know, probably from a safety perspective, the abiraterone might, in fact, be very favorable, but at the same time you have to realize the docetaxel it’s 6 doses and 6 doses only, then you’re done.

Whereas the abiraterone you continue the therapy for a much longer period of time. So, there might be some who choose to be treated with chemotherapy, and I think that that is clearly a benefit for the high volume subset, and for the abiraterone, I think it presents another option.

Are we going to compare the two? Well, we need to, or what about combine the two? We need to do that. So, there’s a lot of path forward here and it just really means that men have more options.

Dr. Farzanna Haffizulla: 

So, further research is needed before you can decide.

Dr. Oliver A Sartor: 

Further research is needed, as always.

Dr. Farzanna Haffizulla: 

Excellent. Well, I want to thank you so much for sharing your expertise and joining us here on PracticeUpdate again.

Dr. Oliver A Sartor: 

Well, glad to be here.

Dr. Farzanna Haffizulla: 

And to our viewers, thank you for joining us for this PracticeUpdate. I’m Dr. Farzanna Haffizulla.

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