Jun 4, 2012

ASCO 2012 Update on advanced prostate cancer treatment

ASCO is the world's largest oncology meeting.  Important new data about abiraterone and MDV-3100 were presented at the meeting.  Both of these drugs have been shown to have a significant benefit for patients with metastatic prostate cancer that is resistant to standard hormonal therapy.

I had the privilege of reviewing the latest developments in treatment of advanced prostate cancer.  The slides for my talk are available here.  It's a large file, so be sure you have a broad band connection to download.  The slides are fairly technical at times, but do include "current status" summary slides that provide a succinct summary of the status of each of the new agents discussed.

To put a smile on your face see Larry's latest cartoon.

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(c) 2012 Tom Beer and Larry Axmaker


  1. Dr. Beer:

    On your way forward slide I did not see a place for XL184. Given the positive results on this, I would have thought it would have a place, or did I miss it.

    Given your placement of Provenge, you must have a notion about its value which I didn't see (I'm non-technical type) Can you add any comments to the slide?

  2. XL-184 is discussed in the talk further in. "Targeted therapy" is the heading that refers to this.

    1. Dr. Beer:

      My questions above were not well framed. The slide I was referring to is the next to last slide (#56 on my machine):

      "The way forward….

      •  Sequencing…if so how?
      –  Little data to guide
      •  Efficacy of sequences has not been studied
      –  How effective is abiraterone after MDV-3100 or the other way around?
      •  Combinations?
      –  Very little data so far
      –  Lots of possibilities

      –  Maximum pathway inhibition
      •  Abiraterone + MDV-3100
      –  Non-overlapping MOA
      •  Alpharadin + chemotherapy
      •  Alpharadin + immunotherapy

      –  Just because we can
      •  Everything
      –  Can’t do it all, need to demonstrate that combination therapy is better than the sum of the
      sequential use of agents
      •  Cost of therapy is becoming a challenge"

      What does't show above is the Current and One Version of the Future sequences of treatment on the right of the slide.

      So there are two questions: XL184 does not appear in the Future sequence of treatments. Is this because it is still in trial or is there some other reason it is not included?

      Provenge is second to the top of the Future sequence. Aren't any subsequent treatments then combined with Provenge for as long as it is effective? You must have some thoughts about the value of Provenge as a precursor to treatments following. Are you able to share?

      Thanks for the slide deck, to me it leads up to the interesting, valid and simple questions raised on this slide. These questions are new to me but logical. They may not be new in your community but to the unwashed like me, they are new.

  3. Got it. XL184 isn't in there because it's too early. Just starting phase III studies. Had to draw the line somewhere. Not an indication of my view of its prospects.

    With regard to Provenge, the logical place for it is early in the sequence. There are no phase III studies in combination so it's hard to anticipate how that might look. In a manner of speaking, since provenge is on board once given, one can think of it as in combination with subsequent drugs. As the landscape changes, and particularly if other immune treatments emerge, we will need more data to know how best to use it.

  4. Dr. Beer:

    EXEL has applied for orphan drug status for cabozantinib in the treatment of thyroid cancer and may obtain early FDA approval for that. Will it then be available for off label use if the practicioner thinks it is appropriate?

  5. Yes. But insurance coverage may not be available.

  6. Hey Doc

    The ASCO trials reports have some of reporters talking about measuring success with the use of CTCs - circulating tumer cells or something like that. Is this test in use in community health situations to measure success as you guys fiddle around with the various treatments for individuals? If not, why not?

  7. CTCs are another way of measuring the response of tumor to treatment. Other methods include scans and PSA tests. CTCs also provide some information about prognosis. They are still a relatively new tool that is finding its place, in my view.

  8. I'm wondering how things are going with these drugs. I haven't heard much about them in the news lately, especially XL-184. Have they gone beyond phase III studies already?