post-ASCO 2018 · PROSTVAC-V/F (PRO) in men with asymptomatic or minimally symptomatic metastatic,...
Transcript of post-ASCO 2018 · PROSTVAC-V/F (PRO) in men with asymptomatic or minimally symptomatic metastatic,...
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post-ASCO 2018
Prostata Kræft- Nyheder fra ASCO 2018
Dag Stormoen Junior Speaker
H-Læge Onkologi
Gedske Daugaard Senior Speaker
Professor Onkologi
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Abstracts
#5000 SPCG-13 Adjuverende Docetaxel ved strålebehandling
#5001 ADT +/- Abiraterone Abiraterone med eller uden LHRH til patienter PSA recidiv med M0HSPC
#5002 Prospect Prostvac til mCRPC
#5006 PSMA PET/CT 68Ga-PSMA11 PET/CT
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A randomized phase III trial between adjuvant docetaxel
and surveillance after radical radiotherapy for intermediate
and high risk prostate cancer: Results of SPCG-13 trial. Presented Monday, June 4, 2018
Abstract #: 5000
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Biokemisk progression PSA >2.0ng/ml
SPCG 13 - Data presented ASCO 2018
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SPCG 13 - Data presented ASCO 2018
INGEN FORSKEL PÅ PSA PROGRESSIONSFRI OVERLEVELSE
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Tendens tyder på effekt hos højrisiko pt.
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KONKLUSION SPCG - 13
- Adjuvant docetaxel øger ikke PSA fri overlevelse efter radikal RT for
intermediær eller højrisiko prostata kræft.
- Biokemisk progressionsrate var lavere end forventet i begge arme i studiet
- Studiet støtter SPCG -12
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A randomized study of finite abiraterone acetate (AA) plus
leuprolide (LHRHa) versus LHRHa in biochemically
recurrent non metastatic hormone naïve prostate cancer
(M0HNPC). Presented Monday, June 4, 2018
Abstract #: 5002
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LHRH agonist +/- Abiraterone for biokemisk recidiv
af M0, hormon naïve PCa (Efstathiou et al):
28.3 mnd (24.2-35.4)
21.1 mnd (19.1-27.2)
HR 0.62 (95% CI 0.44-0.88; p0.007)
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AA+LHRH vs LHRH in M0HNPC med HR 0.62
- Den eksperimentelle arm kom favorabelt ud til fordel for AA + LHRH med en
HR på 0.62.
- Tillæg af Abiraterone Acetat forlænger ikke tid til Testosteron recovery
hvilket er essentielt for QOL og langtidsbivirkninger.
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Results of PROSPECT: A randomized phase 3 trial of
PROSTVAC-V/F (PRO) in men with asymptomatic or
minimally symptomatic metastatic, castration-resistant
prostate cancer. Presented Monday, June 4, 2018
Abstract #: 5006
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FASE 2 i 2010 - Prostvac 8.5mnd OS benefit
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PROSTVAC - Data presented ASCO 2018
Overall survival - ITT
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Accuracy of 68Ga-PSMA11 PET/CT on recurrent prostate
cancer: Preliminary results from a phase 2/3 prospective
trial. Presented Monday, June 4, 2018
Abstract #: 5006
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Keypoints
- 250 patienter blev inkluderet i studiet (38% PSA <1, 82% r/p, 34% Gl. >8)
- PSA < 1 -- fund af læsion i 40%
- PSA > 1 -- fund af læsion i 80%
- 78% af fundne læsioner var ikke lokale
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Lokal behandling
Påvirkning af testosteron niveauet
Behandling efter LHRH agonister
og antiandrogener
Kemoterapi
Efter kemoterapi
Død
Kirurgi/strålebe-handling
Standard antihormon behandling
Tidlig docetaxel
Docetaxel -Taxotere Cabazitaxel - Jevtana
Abirateron - Zytiga
Enzalutamide - Xtandi
Radium-223 – Alfaradin -
Xofigo
Denosumab (Xgeva), Zoledronic Acid (Zometa)
Tidlig abirateron
Strålebehandling med 18 vs 36 mdr. ADT
AD-RAD
Ga-PSMA PET/CT
Prostvac
LHRH + abirateron
x x
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Lokal behandling
Påvirkning af testosteron niveauet
Behandling efter LHRH agonister
og antiandrogener
Kemoterapi
Efter kemoterapi
Død
Kirurgi/strålebe-handling
Standard antihormon behandling
Tidlig docetaxel
Docetaxel -Taxotere Cabazitaxel - Jevtana
Abirateron - Zytiga
Enzalutamide - Xtandi
Radium-223 – Alfaradin -
Xofigo
Denosumab (Xgeva), Zoledronic Acid (Zometa)
Tidlig abirateron
Strålebehandling med 18 vs 36 mdr. ADT
AD-RAD
Ga-PSMA PET/CT
Prostvac
LHRH + abirateron
x x AR-V7 splice varianter
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Among the contributors to castration-resistant Prostate Cancer are AR splice variants that lack the ligand-binding domain
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Lokal behandling
Påvirkning af testosteron niveauet
Behandling efter LHRH agonister
og antiandrogener
Kemoterapi
Efter kemoterapi
Død
Kirurgi/strålebe-handling
Standard antihormon behandling
Tidlig docetaxel
Docetaxel -Taxotere Cabazitaxel - Jevtana
Abirateron - Zytiga
Enzalutamide - Xtandi
Radium-223 – Alfaradin -
Xofigo
Denosumab (Xgeva), Zoledronic Acid (Zometa)
Tidlig abirateron
Strålebehandling med 18 vs 36 mdr. ADT
AD-RAD
Ga-PSMA PET/CT
Prostvac
LHRH + abirateron
x x AR-V7 splice varianter
Pembrolisumab
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Lokal behandling
Påvirkning af testosteron niveauet
Behandling efter LHRH agonister
og antiandrogener
Kemoterapi
Efter kemoterapi
Død
Kirurgi/strålebe-handling
Standard antihormon behandling
Tidlig docetaxel Docetaxel -Taxotere Cabazitaxel - Jevtana
Abirateron - Zytiga
Enzalutamide - Xtandi
Radium-223 – Alfaradin -
Xofigo
Denosumab (Xgeva), Zoledronic Acid (Zometa)
Tidlig abirateron
Strålebehandling med 18
vs 36 mdr. ADT
PARP-hæmmer: patienter med Homolog Recombination Deficiency, forandringer I BRCA eller ATM mutation
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Lokal behandling
Påvirkning af testosteron niveauet
Behandling efter LHRH agonister
og antiandrogener
Kemoterapi
Efter kemoterapi
Død
Kirurgi/strålebe-handling
Standard antihormon behandling
Tidlig docetaxel
Docetaxel -Taxotere Cabazitaxel - Jevtana
Abirateron - Zytiga
Enzalutamide - Xtandi
Radium-223 – Alfaradin -
Xofigo
Denosumab (Xgeva), Zoledronic Acid (Zometa)
Tidlig abirateron
Strålebehandling med 18 vs 36 mdr. ADT
AD-RAD
Ga-PSMA PET/CT
Prostvac
LHRH + abirateron
x x AR-V7 splice varianter
Pembrolisumab
Olaparib + abi vs abirateron
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homologous recombination repair mutation (HRRm) status was assessed using optional tumor (n = 68), whole-blood and plasma samples
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Statistically significant increase in rPFS seen with the combination (13.8 months) vs abiraterone alone (8.2 month), a 5.6 month PFS benefit (HR 0.65, P= 0.03)
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homologous recombination repair mutation (HRRm)
status did not seem to impact this benefit
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Lokal behandling
Påvirkning af testosteron niveauet
Behandling efter LHRH agonister
og antiandrogener
Kemoterapi
Efter kemoterapi
Død
Kirurgi/strålebe-handling
Standard antihormon behandling
Tidlig docetaxel
Docetaxel -Taxotere Cabazitaxel - Jevtana
Abirateron - Zytiga
Enzalutamide - Xtandi
Radium-223 – Alfaradin -
Xofigo
Denosumab (Xgeva), Zoledronic Acid (Zometa)
Tidlig abirateron
Strålebehandling med 18 vs 36 mdr. ADT
AD-RAD
Ga-PSMA PET/CT
Prostvac
LHRH + abirateron
AR-V7 splice varianter
Pembrolisumab
Olaparib + abi vs abirateron
Radium223 standard vs
højdosis vs 12 serier
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Lokal behandling
Påvirkning af testosteron niveauet
Behandling efter LHRH agonister
og antiandrogener
Kemoterapi
Efter kemoterapi
Død
Kirurgi/strålebe-handling
Standard antihormon behandling
Tidlig docetaxel
Docetaxel -Taxotere Cabazitaxel - Jevtana
Abirateron - Zytiga
Enzalutamide - Xtandi
Radium-223 – Alfaradin -
Xofigo
Denosumab (Xgeva), Zoledronic Acid (Zometa)
Tidlig abirateron
Strålebehandling med 18 vs 36 mdr. ADT
AD-RAD
Ga-PSMA PET/CT
Prostvac
LHRH + abirateron
x x AR-V7 splice varianter
Pembrolisumab
Olaparib + abi vs abirateron
Radium223 standard vs
højdosis vs 12 serier ? x
Prostata cancer