The information, views and opinions expressed in this presentation and any accompanying materials are those of the speaker and do not necessarily reflect the views or position of Cardinal Health or VitalSource.

Establishing an Advanced Prostate Cancer Clinic: The Rationale

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Conference Objectives • Discuss key steps and insights into establishing an

advanced prostate cancer clinic and gain insight into the clinical and operational considerations for managing the treatment of prostate cancer in the urology setting.

• Provide information on the practical management of patients on CRPC therapies.

• Learn about the evolving healthcare landscape changes and how to navigate access/affordability.

• Provide guidance on how community urology practices can effectively partner with other healthcare providers.

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Prostate Cancer 2015

220,800 new cases expected 27,540 deaths expected

1 man in 7 will be diagnosed with prostate cancer during his

lifetime. The average age at the time of diagnosis is about 66.

2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics

Prostate cancer is the second leading cause of cancer death in American men

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5

Before 2010, The Last Agent Approved for The Treatment mCRPC was Docetaxel

LHRH agonists Reversible AR blockers

1984-1989

Mitoxantrone 1996

Zoledronic Acid 2002

Docetaxel 2004

Abiraterone (post-chemo)

2011 Abiraterone (pre-chemo)

2012

Radium-223 Enzalutamide (post-chemo)

2013 Enzalutamide (pre-

chemo) 2014

Cabazitaxel Sipuleucel-T

2010

Denosumab 2011

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What is the optimal place for docetaxel in treatment of

metastatic prostate cancer?

Local therapy

Androgen deprivation therapy (ADT)

Therapies after ADT

Death

ADT

mCRPC post-

docetaxel

mCRPC symptomatic

mCRPC mildly

symptomatic

mCRPC

asymptomatic

(failed ADT)

Hormone sensitive

Docetaxel

Moving indication? ADT + Docetaxel

in high-volume

disease?

Around 40% of patients do not respond to first-line docetaxel

Median overall survival of docetaxel + prednisone is ≤ 2 years

Tannock et al. N Eng J Med 2004; 351(15):1502

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Treatment Landscape

Androgen Deprivation

Chemotherapy

Postchemotherapy

Death Local Therapy

Sipuleucel-T

Therapies After GnRH Analogs

and Antiandrogens

Chen Y, et al. Lancet Oncol. 2009;10:981-991. Hofland J, et al. Cancer Res. 2010;70:1256-1264.

Docetaxel Cabazitaxel

Surgery/ Radiation

Standard Androgen Deprivation Therapy

Denosumab, Zoledronic Acid

Radium -223

Enzalutamide

Abiraterone

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Summary

• Therapeutic options for advanced PCa patients now

allow for improved patient-physician shared decision

making.

• Specialization and commitment to the treatment and

management landscape is essential.

• Ongoing and future trials will serve to better inform our

current unmet needs and questions.

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Summary

• Urologists are playing a greater role in the care of

patients with mCRPC.

• With this comes the responsibility of keeping up with the

advancements and self-education around existing and

emerging therapies.

• Monitoring for both disease progression and AEs is an

important aspect of caring for these patients.

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Summary • Urologists are in a unique position to offer extended care for patients

with mCRPC.

• Understanding the basics of assessing disease extent as well as the

patient's needs is important to offering the right care.

• The AUA guidelines are driven by knowing the rate of progression

and characteristics of the metastatic disease, whether the patient is

symptomatic, the patient's overall performance status, and whether

the patient has received docetaxel in the past.

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Summary

• Five new therapies have become available that improve

survival in patients with mCRPC.

• Each has a unique mode of action and strategy to

reduce tumor burden.

• The administration, dosing, cautions, and adverse

events are important for urologists to know in order to

determine which therapy is right for the individual patient.

The information, views and opinions expressed in this presentation and any accompanying materials are those of the speaker and do not necessarily reflect the views or position of Cardinal Health or VitalSource.

A GUIDE TO ESTABLISHING AN ADVANCED PROSTATE CANCER CLINIC

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Objective

• Discuss key insights into establishing an advanced

prostate cancer clinic (APCC)

• Discuss key insights into the integration component for

managing the treatment of prostate cancer in the urology

setting:

o Clinical integration

o Operational integration

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Background

Rising Healthcare costs Aging population expansion

Shifting sites of care

The demographic, clinical, and economic pressures are influencing the healthcare system

Longer time on treatment

Maximizes Value Proposition Quality of care +

Efficient delivery of care

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Shifting Paradigm: Volume → Value

• The healthcare landscape is changing rapidly

• Along with this change begets opportunities for forward thinkers to enhance their urology practice, and

• Also understand the importance of collaboration and sub-specialization

Expanding specialty clinic is an opportunity:

Advanced Prostate Cancer Clinic (APCC)

Advanced OAB center

E/D center

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Why Develop APCC?

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Advanced Prostate Cancer Clinic (APCC) Dedicated Champions Physician Champion

Nurse Champion Administrative Champion

Clinical and Business Integration

Collaboration and Sub-specialization

Success for patients and the urology

practice