April 2015 Prostate Forum

This month’s Prostate Forum, features two investigators at the forefront of advancing prostate cancer treatment. Dr. Neil Shore has been heavily involved in prostate cancer clinical trials for many years. In the conversation in our April issue, he details the clinical trials that have established Xtandi as a major advance in the treatment of prostate cancer.

Dr. Neal ShoreI am particularly excited by the results of the TERRAIN trial he discusses. This trial compared Lupron + Casodex to Lupron + Xtandi. TERRAIN showed a dramatic benefit to Xtandi as compared with Casodex: time to disease progression was 15.7 months compared to 5.8 months. That represents more than a 270% increase in the duration of cancer control.

I can just imagine the response on online patient forums. Why get excited about these results if it did not cure anyone? But members of this audience know that it is unreasonable to expect any single drug to cure advanced, metastatic cancer. Durable complete remissions commonly require drug combinations in which the drugs do not share resistance mechanisms. Indeed, the impact of Xtandi is about as dramatic as you can expect for a single agent.

Toward the end of Dr. Shore’s interview, he comments on the growing importance of biomarkers in tailoring the treatment to the individual patient. This theme is the major focus of the interview with Dr. Mark A. Rubin.

Dr. Rubin is the Director of the Institute for Precision Medicine at Weill Cornell Medical College. He is one of the leaders in the effort to understand prostate cancer at a molecular level.

Dr. Mark A. RubinWhile many physicians and patients focus on the development of new drugs, we will need to understand more about the molecular detail in patients with advanced disease. This will be key, not only in selecting drugs for each patient, but also in knowing how to craft the best drug combinations.

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