Mehmood Hashmi, MD, assistant professor of medicine, University of Kansas Medical Center, discusses the use of immunotherapy in the treatment of patients with prostate cancer.

As in many other cancers, immunotherapy is another available pillar of treatment, says Hashmi. Prostate cancer is a very immunogenic disease, and neoantigens are produced that can be targeted. Single-agent immunotherapy has induced response rates of approximately 10%. Combination therapies are now being explored in an attempt to further enhance response rates. Some of these strategies include dual immunotherapeutic approaches as well as immunotherapy in combination with androgen suppression, explains Hashmi.

In addition to developing synergistic combinations, Hashmi notes that physicians have to identify specific genes through genomic-based testing to further personalize treatments. Even with these advances, immunotherapy will be restricted to certain subsets of patients, states Hashmi.

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Dr. Hashmi on Immunotherapy in Prostate Cancer

Mehmood Hashmi, MD, assistant professor of medicine, University of Kansas Medical Center, discusses imaging modalities in prostate cancer.

Traditionally, physicians use CT scans or bone scans in patients with prostate cancer. Although they help physicians identify a patient’s disease, their sensitivity is not that high. It hovers around 60% to 65%, says Mehmood. Therefore, more advanced modalities are needed to identify the patients who need more aggressive treatment upfront and those who can potentially avoid unnecessary treatment.

Although carbon-11 (C-11) PET scan is a modality that is included in the NCCN guidelines and has approximately 80% sensitivity, it is not readily available at all centers. Prostate-specific membrane antigen (PSMA)-PET scans is another approach that is becoming more common in practice. PSMA scans show higher sensitivity and higher positive predictive values, explains Mehmood.

All of these modalities will help physicians identify the patients who can be treated aggressively in the beginning, as well as those who can avoid unnecessary aggressive surgeries and radiotherapy toxicities, states Mehmood.

Dr. Hashmi on Imaging Modalities in Prostate Cancer

Mehmood Hashmi, MD, assistant professor of medicine, University of Kansas Medical Center, discusses the exciting abstracts in prostate cancer that were presented at the 2018 ASCO Annual Meeting.

The SPARTAN trial was a practice-changing, 2-arm trial that examined the standard androgen deprivation therapy (ADT) and apalutamide (Erleada) versus placebo with ADT, says Hashmi. Investigators looked at metastasis-free survival, in which there was a difference of about 24 months between arms.

In addition to the data surrounding newer therapeutic agents, data regarding new imaging modalities were presented. Included, were prostate-specific membrane antigen scans, which Hashmi states are very promising, as they will help identify the disease earlier.

The role of immunotherapy in prostate cancer was also examined. Although negative trials were reported, they nonetheless paved the way for future combination treatments, says Hashmi. Although PD-L1 inhibitors have shown benefit in many other cancers, physicians are still questioning how immunotherapy can be applied in prostate cancer.

Additionally, a phase II study combined abiraterone acetate (Zytiga) with olaparib (Lynparza) in heavily pretreated patients. Composite results of the trial have led to a phase III trial, says Hashmi.

Mehmood Hashmi, MD

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Dr. Hashmi on Immunotherapy in Prostate Cancer

Dr. Hashmi on Imaging Modalities in Prostate Cancer

Dr. Hashmi on Prostate Cancer Abstracts From the 2018 ASCO Annual Meeting