Prostate Cancer“Highlights from ASCO GU – 2017”

Mohamed Abdulla M.D.

Prof. of Clinical Oncology

Cairo University

Astellas Astellas Symposium02/04/2017Grand Nile Tower

Member of Advisory Board, Consultant, and Speaker for:

• Amgen, Astellas, AstraZeneca, Hoffman la Roche, Janssen Cilag, Merck Serono, Novartis, Pfizer, Mundipharma, MSD

Speaker Disclosures:

Outline:

1. Disease demographics and screening.

Demographics of Prostate Cancer:Metastatic Disease at Presentation:

Gilbert Welch et al. NEGM. 2015;373:1685-1687

50%

Demographics of Prostate Cancer:Changes in Mortality Rates:

Kelly et al. EUROPEAN UROLOGY 71 (2017) 195–201

Demographic: Context

Demographic: Metastases

Demographics & USPSTF

Demographics & USPSTF

Screening: PLCO

Outline:

1. Disease demographics and screening.

2. Pathology – Classification.

Pathology - Classification

Pathology - Classification

Outline:

1. Disease demographics and screening.

2. Pathology – Classification.

3. Localized Disease: Treatment.

Localized disease - Treatment

Localized disease - Treatment

Localized disease - Treatment

Localized disease - Treatment

Localized disease - Treatment

Localized disease – Secondary Ca

Localized disease - Surgery

Localized disease - Surgery

Localized disease - Surgery

Localized disease - Surgery

Localized disease - Radiation

Localized disease - Radiation

Localized disease - Radiation

Salvage Radiotherapy: GETUG-AFU 16

Salvage Radiotherapy: GETUG-AFU 16

Salvage Radiotherapy: RTOG 9601

Salvage Radiotherapy: RTOG 9601

Outline:

1. Disease demographics and screening.

2. Pathology – Classification.

3. Localized Disease: Treatment.

4. Metastatic Disease: Treatment.

Metastatic disease: Stampede

Metastatic disease: Stampede

Metastatic disease: Stampede

Metastatic disease: Docetaxol

Metastatic disease: Docetaxol

Metastatic disease: TERRAIN RCT

Metastatic disease: STRIVE RCT

Outline:

1. Disease demographics and screening.

2. Pathology – Classification.

3. Localized Disease: Treatment.

4. Metastatic Disease: Treatment.

5. DNA Repair Genes.

Slide 75

TOPARP Phase 2 Trial:

Mateo etl. N Engl J Med.2015:373;18.

DNA Repair & Metastatic PCa

DNA Repair & Metastatic PCa

Outline:

1. Disease demographics and screening.

2. Pathology – Classification.

3. Localized Disease: Treatment.

4. Metastatic Disease: Treatment.

5. DNA Repair Genes.

6. Intrinsic Subtypes of Prostate Cancer.

Introduction

PAM50 clustering readily identifies luminal (A & B) and basal subtypes in prostate cancer

Luminal B prostate cancers have worse outcomes compared to Luminal A or Basal subtypes

Multivariable analysis for metastatic progression

Different biological pathways are up- or down-regulated in luminal versus basal subtypes<br />

Does subtype predict response to ADT?

Which patients should receive androgen deprivation early in the course of recurrence?

Which patients should receive androgen deprivation early in the course of recurrence?

Not all patients benefit from the addition of anti-androgen therapy to salvage radiotherapy

The next step: Molecular stratification

Conclusions

Thank You