Medicine Matters oncology

ESMO had a lot of very interesting data. Amongst the data that was presented was a post-hoc analysis. It was from the STAMPEDE. We've had five trials on novel androgen signaling inhibitors in metastatic hormone-naive prostate cancer-- all positive, great data. Now we have three trials with docetaxel. Two were positive. One was negative. But the STAMPEDE, I think, was the one that gave the strongest push in using docetaxel in metastatic hormone-naive prostate cancer. Granted, it was all de novo, what they tested.

But this time, they came back, and they have almost a seven-year median follow-up, which is a long time. And, as somebody said, they actually looked at whether size matters, which is a stupid comment. But they actually looked at whether low volume or high volume made a difference in performance. So they didn't see a difference, which is quite interesting because in CHAARTED, we saw the opposite. And there's various reasons that could explain it.

But for everyday purposes in the clinic, we should reach for either docetaxel or an androgen-signaling inhibitor such as abiraterone based on availability and what we think is best for our patient. Because it appears that this stratification based on volume or risk may not matter that much. Why? Because these phenotypic findings, such as volume and risk, are actually just poor surrogates for the biology of the disease.

And what we're missing still is the determinants of the biology of the disease, which, for instance, breast cancer does so well. They look at ER/PR. They look at HER2. They look at Ki-67. We don't have these markers yet. So we need to rely on our clinical acumen and instinct to treat our patients-- of course, based on the data. And that's my main take-home message. I believe that both agents both mechanisms of actions have a real role in prostate cancer.