Where Are We Now With Advanced Prostate Cancer Research?

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With all of the advances in other types of cancer, where does the field of prostate cancer stand?  Patient Power Founder, Andrew Schorr, speaks with genitourinary clinician and researcher, Dr. Russell Szmulewitz, about the latest prostate cancer updates.  Although more research needs to be done on the adaptive mechanisms of prostate cancer, Dr. Szmulewitz is very hopeful based on hormone therapies, current medications, and the climate of collaboration among international researchers. 

Sponsored by the Patient Empowerment Network through educational grants from Astellas, Medivation, Inc. and Sanofi. 

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Hello and welcome to Patient Power. I'm Andrew Schorr. I'm sitting with a gentleman who devotes his life to trying to advance prostate cancer care, the knowledge we have of it, certainly to help men with advanced prostate cancer, Dr. Russell Szmulewitz from the University of Chicago.  Thank you for being with us. 

Dr. Szmulewitz:

You're welcome.  Good morning. 

Andrew Schorr:

Dr. Szmulewitz, you have a lab, and you see patients in clinic.  Where are we now?  It seems like we've made a lot of progress in the last few years in having options for men with advanced prostate cancer, so they can live with it. 

Dr. Szmulewitz:

Yeah, that's true. So where are we now? You know, we are in a position where we have many options to offer our patients with advanced disease that sort of in a way makes the disease a chronic illness that patients can live with like they would live with diabetes or heart disease.  And for many of our patients with advanced disease, they are living many years with the disease because of these new medications over the last few years.

Andrew Schorr:

But cancer is wily, and it tries to figure a way around the treatments that you have.  Do you feel that some of the treatments you have now could be the bridge to what's next, what maybe you're studying in the lab, so that a man with advanced prostate cancer can say, well, if this drug wears out and the cancer starts to progress, maybe Dr. Szmulewitz and your colleagues around the world will have developed something new? 

Dr. Szmulewitz:

Yeah, so you're right. Cancer is wily. It is sneaky, and it is very, very flexible, so it adapts to all the therapies that we give it, and I think that what we now are understanding is that the way that they adapt is heterogeneous, and that is one of the major challenges in prostate cancer is that not every patient's tumor will adapt in the same way. 

And so I think that what we are trying to understand now is what are those mechanisms of adaptation, how is the cancer adapting to the hormone or the chemotherapy or the immunotherapy that we're giving it, and in an individual understanding that adaptation so that we can specifically target that adaptive mechanism.  That's the way forward. 

So, yes, these therapies are in a way a bridge while we in the laboratory and in the clinical research try to figure out these mechanisms, but obviously our hope is eventually to bring these forward so that we're not in this position. 

Andrew Schorr:

Now, where are we now with understanding what an individual's prostate cancer situation is?  In so many other cancers we're looking at different oncogenes, the cancer genes that are active for them, and having targeted treatments for them.  Where are we with that with prostate cancer? 

Dr. Szmulewitz:

So it's a great question. I think that we're not as far along as we are with other diseases.  We—other diseases have known mechanisms, as you say, known oncogenes, and for prostate cancer in some ways we're way ahead because the hormone therapy, the androgen receptor, which is the hormone receptor we know is a common driver, a common oncogene, if you will, that drives the vast majority of prostate cancer. And so in a way we're ahead, because we know that that therapy targets the disease.

But where we're behind is in the adaptation mutations, the adaptation mechanisms, and part of that is getting biopsy material.  Getting, you know, interrogating a patient's tumor multiple steps along the way is something in prostate cancer that we're just now starting to do more frequently. Whereas in other cancers, like leukemia, it's very much easier to do, or in breast cancer they do it more, in lung cancer they do it more, and I think that is the way forward, to really get specific material each step of the way from the patient, bring it back to the lab, look at mutations, look at these mechanisms of adaptation, so we can then target the appropriate ones. 

Andrew Schorr:

So one other thing I want to ask you about, again, what we hear about from other cancers and even men are reading medical journals and hearing the news, and they hear that immunotherapy, some call it immuno-oncology, is happening in other cancers where the immune system is being turned on more, if you will, for surveillance to fight the cancer. 

Dr. Szmulewitz:

Yeah.

Andrew Schorr:

Where are we with that in prostate cancer?

Dr. Szmulewitz:

So in prostate cancer, we're one of the first solid tumors to actually have an FDA-approved therapeutic in sipuleucel-T. So that is an adoptive vaccine type therapy that's FDA approved and helps men live longer with their disease, especially if we give it earlier in the course of resistant disease.  

But where we are behind in prostate cancer compared to melanoma or lung cancer is in these checkpoint blockades. So we know that the tumor often will make signals that tell the immune system, don't attack me and those checkpoints. So in many diseases and many cancers we now have therapies that block those blockades, then they allow the immune system to come in. 

Now, in prostate cancer, at least in the early investigation, those baseline checkpoint blockade inhibitors, those blockers of the blockers, haven't been very active, and the question is why is that? And I think that the next generation for prostate cancer immune research is to figure out what about the environment of prostate cancer is less immunostimulatory so that we can get the immune cells in there, and then we can block the blockade.  So I think that we will get there, but I think we first have to figure out why prostate cancer is different. 

Andrew Schorr:

So in your lab and in labs around the world, you're detectives. You're really a detective.

Dr. Szmulewitz:

That's right. 

Andrew Schorr:

Trying to figure out, get these answers. So as a detective on the case, particularly when prostate cancer advances, for the men listening and their wives and partners, family members, are you hopeful as a detective?

Dr. Szmulewitz:

Well, of course.  We're very hopeful.  I think that we have an international community now of detectives, if you will, of investigators that are coming together to identify what the major problems are and to make sure that we're all focused on the same goal in both prolonging life, making life better for men who are suffering and ultimately curing the disease. 

And I think that what I'm most hopeful about is I look across at meetings and we all know each other now, we all work together, we have—there's less of this infighting competition. There's much more collaboration, really, internationally, and so I think that we will make progress because we are fighting for the same goals.  And there is now??and there's support.  There's support from philanthropy, there's support from governments, there's support from industry, so these go hand?in?hand.  So, yeah, I am quite hopeful. 

Andrew Schorr:

Well, that's good news.  I am glad you're working together.  I'm glad you're a relatively young detective… 

Dr. Szmulewitz:

Yes. 

Andrew Schorr:

…who hopefully during your career you can report back to us, Hey, Andrew, we've made this progress, we now understand this, men are living longer and living better.  

Dr. Szmulewitz:

I sure hope so. 

Andrew Schorr:

Thank you for all you do. Andrew Schorr with one of the chief detectives here, Dr. Russell Szmulewitz from the University of Chicago with I think hopeful news for men and families dealing with advanced prostate cancer. 

Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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