Philip W. Kantoff, MD, chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center and a 2014 Giants of Cancer Care® winner for Genitourinary Cancer, discusses future research efforts in prostate cancer.

 provided the field of prostate cancer with an abundance of research with regard to novel treatment strategies.

​Other than PARP inhibitors, few treatment options ​are available for patients with prostate cancer who harbor DNA repair gene abnormalities, Kantoff explains. As such, the field is actively trying to improve PARP inhibition by evaluating these agents in combination with other therapies​, says Kantoff.

Additionally, ongoing research is evaluating BCL-2 inhibitors in combination with other agents​, Kantoff explains.

These investigational treatment strategies could have utility in men with prostate cancer ​pending further positive data, Kantoff concludes.

Videos

Philip W. Kantoff, MD, discusses future research efforts in prostate cancer.

Dr. Kantoff on Future Research Efforts in Prostate Cancer 

Philip W. Kantoff, MD, chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center and a 2014 Giants of Cancer Care® winner for Genitourinary Cancer, discusses the rationale to evaluate VERU-111 in metastatic castration-resistant prostate cancer (mCRPC).

VERU-111 is a​n oral tubulin inhibitor, says Kantoff. Taxanes​, such as docetaxel and cabazitaxel (Jevtana), are also active against tubulin​, Kantoff explains.

​Although taxanes and VERU-111 are active against tubulin, their distinct mechanisms of action are not fully defined, explains Kantoff.

Currently, ​taxanes have demonstrated modest activity in patients with mCRPC, ​although docetaxel has shown significant activity in the metastatic hormone-sensitive setting, Kantoff concludes.

Philip W. Kantoff, MD, discusses the rationale to evaluate VERU-111 in metastatic castration-resistant prostate cancer. 

Dr. Kantoff on the Rationale to Evaluate VERU-111 in mCRPC

Philip W. Kantoff, MD, chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center and a 2014 Giants of Cancer Care® winner for Genitourinary Cancer, discusses the need to develop new therapies in metastatic castration-resistant prostate cancer (mCRPC).

Many novel drugs have been introduced into the paradigm of mCRPC over the past decade. However, many of these agents have been moved into earlier lines of treatment for men with metastatic hormone-sensitive prostate cancer or nonmetastatic CRPC, says Kantoff. 

For example, androgen-signaling agents or newer generation antiandrogens, such as enzalutamide (Xtandi), darolutamide (Nubeqa), apalutamide (Erleada), and abiraterone acetate (Zytiga) have been moved into earlier lines of therapy, Kantoff says. Additionally, sometimes docetaxel is brought into earlier lines of treatment.

As a result, the mCRPC setting is in need of additional treatment options, Kantoff explains. 

Philip W. Kantoff, MD, discusses the need to develop new therapies in metastatic castration-resistant prostate cancer.  



Dr. Kantoff on the Need to Develop New Therapies in mCRPC 

Philip W. Kantoff, MD, chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center and a 2014 Giants of Cancer Care

 winner for Genitourinary Cancer, discusses current approaches for patients with metastatic hormone-sensitive prostate cancer (mHSPC), and nonmetastatic (nm)/metastatic castration-resistant prostate cancer (mCRPC) who progress on androgen blocking agents.

Androgen blocking agents are introduced either in the context of mHSPC, nmCRPC, or mCRPC, says Kantoff, who adds that they seem to work a bit better in the earlier-line setting and are more frequently used in these disease subtypes.

However, when a patient develops resistance to these agents, such as abiraterone acetate (Zytiga), enzalutamide (Xtandi), darolutamide (Nubeqa), and apalutamide (Erleada), their ability to be treated successfully with another 1 of those agents is minimal, says Kantoff. That is when patients move onto taxanes, such as docetaxel and cabazitaxel (Jevtana), or sipuleucel-T, which is an immunotherapy agent that was FDA-approved 10 years ago, concludes Kantoff.

Philip W. Kantoff, MD, discusses current approaches for patients with metastatic hormone-sensitive prostate cancer, and nonmetastatic/metastatic castration-resistant prostate cancer who progress on androgen blocking agents.

Dr. Kantoff on Approaches for Progressive Prostate Cancer Following Androgen Blockade

Philip W. Kantoff, MD, chair of the Department of Medicine, Memorial Sloan Kettering Cancer Center and a 2014 Giants of Cancer Care winner for Genitourinary Cancer, discusses the combination of docetaxel (Taxotere) chemotherapy and androgen deprivation therapy (ADT) in the setting of metastatic hormone-sensitive prostate cancer.

Considering the positive results in overall survival from the CHAARTED and STAMPEDE trials, which combined ADT with docetaxel, the next step became determining which patients would benefit from this combination.

Kantoff concludes that hormone-sensitive patients with high-volume metastatic disease and newly-diagnosed patients with de novo metastatic disease would benefit and should be treated with the combination.

Biologically, the question remains of why docetaxel is more effective in hormone-sensitive patients with high-volume metastatic disease. According to Kantoff, biomarkers must be found to answer this question and determine the sensitivity to docetaxel in hormone-sensitive disease.

Dr. Kantoff on Docetaxel Plus Androgen Deprivation Therapy in Prostate Cancer

Philip W. Kantoff, MD, chairman of Medicine at Memorial Sloan Kettering Cancer Center and a 2014 Giants of Cancer Care winner for Genitourinary Cancer, discusses the role that chemotherapy treatment with docetaxel will continue to have in patients with prostate cancer. Kantoff shared this insight in an interview during the 2016 

 State of the Science Summit on Genitourinary Cancers.

While immunotherapy agents and other novel therapies are being studied to advance outcomes in the field of prostate cancer, there continues to be a role for docetaxel for select patients with metastatic disease, Kantoff explains.   

Docetaxel has had more of a modest role in men with metastatic castration-resistant prostant cancer, as it has only improved survival by approximately 2 to 3 months, he explains. However, it is said to have much more of a substantial and profound benefit in patients with hormone-sensitive metastatic prostate cancer. The survival improvements observed with docetaxel, he adds, are much longer than survival curves seen with other agents in this patient population. Therefore, it remains to be a significant component of the current armamentarium for these patients.

However, whether chemotherapy will remain in the treatment landscape in the next 5 to 20 years, he says, is to be determined.

Philip W. Kantoff, MD, chairman of Medicine at Memorial Sloan Kettering Cancer Center and a 2014 Giants of Cancer Care winner for Genitourinary Cancer, discusses the role that chemotherapy treatment with docetaxel will continue to have in patients with prostate cancer. Kantoff shared this insight in an interview during the 2016 OncLive State of the Science Summit on Genitourinary Cancers.

Philip W. Kantoff, MD

Articles

Dr. Kantoff on Future Research Efforts in Prostate Cancer

Dr. Kantoff on the Rationale to Evaluate VERU-111 in mCRPC

Dr. Kantoff on the Need to Develop New Therapies in mCRPC

Dr. Kantoff on Approaches for Progressive Prostate Cancer Following Androgen Blockade

Dr. Kantoff on Docetaxel Plus Androgen Deprivation Therapy in Prostate Cancer

Dr. Kantoff on Evolving Role of Docetaxel in Prostate Cancer Treatment