By Dr David Pook.
At the recent Australia and New Zealand Urological and Prostate (ANZUP) Cancer Trials Group annual scientific meeting held recently in Melbourne, there was a focus on genomics as well as translating scientific findings into clinical practice.
Robert Bristow of Princess Margaret’s Hospital in Toronto described the challenge of treating local prostate cancers with radiotherapy given that up to half will fail treatment. Dr Bristow presented his research into prognostic factors in prostate cancer and explained that cancers classed as intermediate risk based upon staging, PSA and Gleason score were unlikely to fail radiotherapy or surgery alone if they did not have genomic instability or hypoxia. This patient group could safely avoid hormone therapy. Patients whose tumours have these adverse factors may benefit from additional therapy in addition to surgery or radiotherapy and clinical trials are underway in this higher risk group.
Similarly, Eric Klein from the Cleveland Clinic in the USA explained the difficulties in selecting which prostate cancer patients require surgery and which patients can safely be followed with active surveillance. His work involved gene profiling the prostate cancers of 500 men who had undergone radical prostatectomy. When the gene signatures were matched to prostate cancer recurrence and death, a 295 gene profile was able to predict recurrence independent of tumour stage and grade and PSA. This profile was stable across different tumour foci in the same patient, which made it more likely it could be detected via a biopsy. Using the gene profile, Dr Klein is better able to select lower risk patients suitable for active surveillance or higher risk patients who should consider early surgery. Importantly, use of the gene profile replaced the need for a repeat biopsy in patients undergoing active surveillance, which allowed them to avoid potential complications.
Lisa Horvath from the Chris O’Brien Lifehouse showed that she had identified microRNAs in the blood of men with prostate cancer that could predict whether or not they would respond to treatment with docetaxel chemotherapy. Nearly 50 candidates were discovered in vitro and these were measured in 97 patients commencing chemotherapy. Sixteen microRNAs were associated with response to chemotherapy. Higher levels of miR-200a, miR-200b, miR-200c and miR-429 predicted a shorter survival and possibly identified a group of patients in which more intensive therapies should be considered. In addition, these microRNAs may be playing an important role in Docetaxel resistance and so may be targets for further therapies.
Addie Wooten from the Royal Melbourne Hospital demonstrated her online self-directed psychological intervention for men with prostate cancer known as My Road Ahead. One hundred and forty four patients were randomised to the online intervention and/or access to a moderated forum. The online intervention was superior to the forum in improving sexual satisfaction in these men and is the first time such an intervention has been able to achieve this.
Alison Zhang from Westmead Hospital described a protocol for adjusting the dose of sunitinib in 36 patients with metastatic kidney cancer to achieve mild toxicity on more than 10 out of 42 days of treatment. This resulted in a dose range of 25-75mg daily for two out of three weeks and 90% of patients achieved a target blood concentration of the drug. This is important given the recommended dose of sunitinib is 50mg, meaning that a proportion of patients are not receiving an adequate dose.
Further studies presented at this years ANZUP ASM can be found at ANZUP.org.au. Dr David Pook is a medical oncologist at the Cabrini Hospital Malvern and Monash Cancer Centre, Monash University.