[ Inglês] Precision Medicine for Prostate Cancer: Treatment News Announced at ASCO 2018

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Topics include: Treatments

What can genetic testing reveal about your cancer? What tests are recommended for prostate cancer patients? On location at the 2018 American Society of Clinical Oncology (ASCO) meeting in Chicago, noted expert Dr. Heather Cheng, from Seattle Cancer Care Alliance, discusses what mutations indicate about risk and treatment strategy, tools available to match therapies to a patient’s genetic profile, and gives updates on other emerging approaches. Dr. Cheng also shares clinical results from the GENTLeMEN study, also known as a trial evaluating genetic testing for men with metastatic prostate cancer, and the potential link between breast and prostate cancer mutations. Watch now to find out the latest prostate cancer treatment research.

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Transcript

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Andrew Schorr:

Hello and welcome to Chicago and the big ASCO, American Society of Clinical Oncology, convention where doctors from around the world come.  One of the topics discussed is prostate cancer, and an expert from the Seattle Cancer Care Alliance is with me, Dr. Heather Cheng.  Thanks for being with us. 

Dr. Cheng:

Thank you for the invitation.

Andrew Schorr:

So one of the things, we're hearing so much now about I guess what's called precision medicine, so that not all prostate cancer's alike, not all of any cancer is alike, and you're looking at genes that have gone awry, and you're really into that, and I know you've been speaking about that here.  So tell me how these genetic analyses is becoming important in prostate cancer. 

Dr. Cheng:

It's really exciting time in prostate cancer, particularly in the advanced disease setting, which—I'm a medical oncologist so.  What we've learned is that of men with metastatic prostate cancer in the latest stages that's resistant to the hormone therapy that about a quarter of them have these mutations in DNA repair. 

The excitement around that is that there are clear treatment opportunities for patients who have those alterations both on clinical trials of PARP inhibitors as well as platinum chemotherapies, and then if patients are not able to get to clinical trials for some reason even though we always encourage that, is that they can still consider platinum chemotherapy. 

Andrew Schorr:

All right.  Let me just about over that for a second.  So what you're saying is that for men maybe with the most advanced prostate cancer if you can get a clear picture of what genes have gone awry, you may have either an approved therapy, combination or something in trials that can help. 

Dr. Cheng:

That's right.  And if these are treatments that we wouldn't otherwise be considering, so it's essentially a net addition to the toolbox for these patients. 

Andrew Schorr:

So you have to know what you're dealing with.  Okay.  So what should patients be asking for so that they and their doctor, where they have advanced prostate cancer, get what's right for them? 

Dr. Cheng:

I think that's somewhat challenging to answer simply because there are many options.  I would say that the tests available now to determine if you have those mutations are varying.  There are many very good ones, but the interpretation matters as well.  So I think having a discussion with your doctor, asking about tests that can look at tumor mutations. 

The other part of it is that some of those mutations can be inherited, and that's the other component.  If those are inherited, which is about half of the men with DNA repair mutations have it as an inherited mutation, that's something that's also important for the family members to be aware of, because it could change how they manage their risk and their health.  They can be proactive about it. 

Andrew Schorr:

Okay.  So let's talk about that.  So there are two kinds of gene situations, I guess. 

Dr. Cheng:

Yes. 

Andrew Schorr:

One is did you have blue eyes or no hair like my—I developed that from my family, or whatever affected those sorts of things that you're born with, and then there are others where healthy genes kind of go awry. 

Dr. Cheng:

Right. 

Andrew Schorr:

Okay?  And you now are developing tests that can look at that in men with advanced prostate cancer. 

Dr. Cheng:

That's right.  So you can test both what you inherited, your blue eyes, or if your eyes suddenly turn—or you wore blue—you know, you have purple contacts, that would be something that would be in the cancer, but it wouldn't be something that would be passed on.  You can test for both of those. 

Andrew Schorr:

Okay.  And just so people understand, I know you have this sort of alphabet soup of letters and numbers for genes.  Are there certain genes related to prostate cancer that patients should bring up with their doctor?  Gee, should we test for blah? 

Dr. Cheng:

Yeah.  I think the important, the most important genes at this time that we have an action or a treatment associated with are BRCA2, which many people know of from breast and ovarian cancer. 

Andrew Schorr:

Breast cancer, yeah. 

Dr. Cheng:

But the important thing is that those genes also, or BRCA2 also affects men.  Those at risk of prostate cancer are at higher risk of developing prostate cancer as well as a more aggressive prostate cancer, and there's a treatment option. 

Andrew Schorr:

So that would be hereditary.  That would be what you're born with. 

Dr. Cheng:

You can also get those mutations not inherited. 

Andrew Schorr:

Oh, wow. 

Dr. Cheng:

You can develop mutations in the same genes just by kind of happenstance. 

Andrew Schorr:

Okay.  All right.  Now, you have various studies going on at the Seattle Cancer Care Alliance.  One has a really cool name, the GENTleMen Study.  What is that? 

Dr. Cheng:

GENTleMen Study stands for genetic testing for men with metastatic prostate cancer because we know that—and this is the genetic or the inherited component of it—men with metastatic prostate cancer is about a 10 percent higher prevalence in that population of having inherited cancer risk genes that are the same ones like BRCA2, BRCA1.  And so those are genes that important for men to know about with advanced disease for their treatment and for their families. 

Andrew Schorr:

Okay.  So just like women who may have that hereditary connection to breast cancer or ovarian cancer in their family, famous one we know about is Angelina Jolie, the famous celebrity actress, is if that's the case in a man with prostate cancer, then there's monitoring that would go on with his family to avoid the same fate. 

Dr. Cheng:

Yes, that's right.  And that's the other—the important point from that from what you just said, to emphasize, is also that men should be thinking about not just the family history of prostate cancer but also asking and thinking about, oh, did Aunt Mary have breast cancer and did Aunt Josephine have ovarian cancer?  How old were they when they had their diagnosis? 

Andrew Schorr:

I never heard of that before.  Women know that if you have a family history of breast cancer or ovarian, or mom did or your grandmother or your aunt or your sister, maybe get tested genetically, but now you're saying for men, now let's include prostate cancer as like in your study, the GENTleMen Study. 

Dr. Cheng:

Right.  So it's men should be aware not only of the prostate cancer in their family but the other cancers. And any details about that should be shared with their doctors, because that might be critically important information. 

Andrew Schorr:

Wow.  So we got get that word out to doctors around the world. 

Dr. Cheng:

Yes.  And patients.

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Page last updated on May 20, 2019