Medicine Matters oncology

The current study is a pretty important trial, given it's one of the first prospective studies that really show us that sequence matters. This is a study that in terms of the presentation yesterday follows up looking at quality of life. Many of the patients were symptomatic on this trial with pain. And probably not surprising to many of us, chemotherapy in this setting actually improved pain significantly, compared to the alternative androgen receptor antagonist and didn't diminish quality of life long-term.

I think that's comforting, I mean, given the fact that it was a survival advantage in the study, the fact that, probably, not surprisingly, when you use an active drug, because the alternative AR drug wasn't active, which is why there was a survival benefit, that not only this chemotherapy improve symptoms, but that it doesn't cause a detriment in quality of life compared to the alternative agent. So this concept that chemotherapy is toxic, in a sense, in this study, just doesn't bear out. So I think this was a comforting piece of data to accompany the original presentation.

So in the non-metastatic castration-resistant setting, three large randomized trials, all now introducing this concept of PFS2. I think the reality is is that it's probably clinically relevant measure. It probably reinforces the fact that there that these drugs have significant activity. One of the challenges, because none of the studies are mature enough yet to show a potential survival benefit, it's not truly a surrogate of that, but certainly it's trending in the right direction.

I think we want to make more of it than what it is. It is, in a sense it's probably clinically meaningful. I'm not sure it makes us make decisions in a different way per se. The fact that two studies now in this class have shown similar benefit is again encouraging. So I think it's good to see. And ultimately, it's about, will we see a survival benefit, which would really make this a much more important observation.

So STOMP is one of the early randomized trials testing the concept of management in the oligometastatic setting. This is a bit of an update. Trials not obviously fully mature yet.

It's another data point along the way. I mean, the challenge in oligometastatic metastatic disease is, what are the endpoints? Is it survival?

Is it time off of hormonal therapy? Is it time delay to needing hormonal therapy? There are a lot of these challenges. So I think STOMP is important, because, again, it's one of the forerunners of a multitude of studies that are going to ultimately help us understand how to go forward.