Daniel P. Petrylak, MD, Professor of Medicine, Program Director, Genitourinary Oncology Section, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses the research and concerns surrounding cytotoxic agents for the treatment of castration-resistant prostate cancer (CRPC).

Numerous phase III trials looking at the combination of docetaxel with novel therapies, bone targeted agents, or angiogenesis inhibitors have all failed to demonstrate a survival benefit when compared to docetaxel alone. Petrylak believes that research may not be looking at the correct targets or the possibilities have been exhausted for initial cytotoxic therapy.

The taxane cabazitaxel is currently in randomized trials that compare it to docetaxel in the first-line setting. This agent is currently approved for the second-line in advanced CRPC, following progression on docetaxel. Discovering the best patients for either docetaxel or cabazitaxel is an important area of research, especially when considering newly approved hormonal therapies and possible combinations.

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Dr. Daniel Petrylak, from Columbia University Medical Center, Discusses Chemotherapy in Prostate Cancer

Dr. Petrylak on Chemotherapy in Prostate Cancer

Daniel P. Petrylak, MD, Professor of Medicine, Co-Leader of Prostate Cancer, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses the new isotope agent radium-223 (Alpharadin).

The ALpharadin in SYMptomatic Prostate CAncer (ALSYMPCA) trial that investigated radium-223 for prostate cancer with bone metastases was the first trial to demonstrate an overall survival benefit for an isotopic agent. This agent is set apart by its tolerability when combined with hormonal therapies and chemotherapy.

Radium-233 combines well with docetaxel, something that sets it apart from other approved radiopharmaceuticals. The ALSYMPCA trial investigated the agent in patients that were post — or deemed unfit to receive docetaxel.

Further studies need to be done to determine how to sequence these drugs in a manner that creates a minimum amount of toxicities.

Dr. Daniel Petrylak, from the Herbert Irving Comprehensive Cancer Center, Discusses the Isotope Radium-223

Dr. Petrylak Discusses the Isotope Radium-223

Daniel P. Petrylak, MD, Professor of Medicine, Co-Leader of Prostate Cancer, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses a need to create a solid guideline for sequencing castrate-resistant prostate cancer (CRPC) therapies.

Petrylak explains there is currently very little information to help clinicians determine the order of treatment for CRPC. There are 5 drugs that are currently on the market, or will soon be on the market, for very similar clinical niches within this disease. These drugs include the chemotherapy microtubule inhibitor cabazitaxel (Jevtana), androgen receptor antagonists such as the recently approved abiraterone acetate (Zytiga) and the investigatory MDV3100, the exploratory alpha-emitting radiopharmaceutical radium-223 (Alpharadin), and the immunotherapy sipuleucel-T (Provenge) that can be given to patients that fail docetaxel (Taxotere), or have had one docetaxel regimen.

Without a thorough understanding of the biology of these drugs it is difficult to know how they should be sequenced. Petrylak feels that a test should be developed that indicates which drug or treatment is the best in any given situation. Without a test clinicians can only use their best judgment and usually prescribe chemotherapy to rapidly progressive patients and hormonal agents for chemotherapy resistance.

The lack of a scientific method to decide the treatment has led to disappointment within the oncology community and will be the focus of study in the future.

Dr. Daniel Petrylak from Herbert Irving Comprehensive Cancer Center Discusses Sequencing Prostate Cancer Therapies

Dr. Petrylak on Sequencing Prostate Cancer Therapies

Daniel P. Petrylak, MD Professor of Medicine, Program Director of the Genitourinary Oncology Section in the Division of Hematology/Oncology and Co-Leader, Prostate Cancer in the Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center on the Recent Developments in Prostate Cancer

Recent Developments in Prostate Cancer

Daniel P. Petrylak, MD, Professor of Medicine, Program Director of the Genitourinary Oncology Section in the Division of Hematology/Oncology and Co-Leader, Prostate Cancer in the Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center Explains the Difficulties Facing During Prostate Cancer Clinical Trials 

Daniel P. Petrylak, MD, from Columbia University Medical Center Explains the Difficulties Facing During Prostate Cancer Clinical Trials 

Daniel P. Petrylak, MD

Articles

Dr. Petrylak on Chemotherapy in Prostate Cancer

Dr. Petrylak Discusses the Isotope Radium-223

Dr. Petrylak on Sequencing Prostate Cancer Therapies

Recent Developments in Prostate Cancer

Dr. Petrylak Explains Prostate Cancer Clinical Trial Difficulties