David I. Quinn, MD, MBBS, PhD, FRACP, FACP, associate professor of medicine, section head, Genitourinary Oncology, Division of Cancer Medicine and Blood Diseases, Department of Medicine, Keck School of Medicine, discusses the rise of novel hormonal therapies in prostate cancer.

Many of the novel hormonal therapies in prostate cancer are being moved earlier into treatment with a notable improvement in survival, says Quinn. For example, there has been a lot of interest in bringing the agents that were previously FDA approved in castration-resistant prostate cancer (CRPC) to patients with hormone-sensitive disease. In the phase III LATITUDE study, abiraterone acetate (Zytiga) showed an improvement in survival that rivaled giving docetaxel to patients with high-risk hormone-sensitive disease. As such, that became a new option for those patients, says Quinn.

In the phase III STAMPEDE study, abiraterone was tested in a broader group of patients and also showed a benefit, particularly in high-risk patients. Despite the benefit that was observed across the entire study population, the risk-benefit ratio was not as impressive in low-risk patients, adds Quinn. Because these patients have an excess risk of complications—particularly cardiovascular, from being on abiraterone&mdash;clinicians should be cautious about prescribing abiraterone to patients with low-risk disease. Notably, abiraterone is going to become generic in the United States, which may increase patient access, he concludes.

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Dr. Quinn on Novel Hormonal Therapies in Prostate Cancer

David I. Quinn, MD, MBBS, PhD, FRACP, FACP, associate professor of medicine, section head, Genitourinary Oncology, Division of Cancer Medicine and Blood Diseases, Department of Medicine, Keck School of Medicine, discusses the biology of renal cell carcinoma (RCC).

It's important to understand that the modern therapeutics that are available in RCC were developed based on the molecular makeup of the disease. RCC is primarily driven by pathways such as angiogenesis, mTOR, and an altered immune system that is targetable in most cases, says Quinn. These factors are critical when it comes to understanding the therapy of RCC, he adds. They are also important when it comes to understanding some underlying principles of treatment. A patient with newly diagnosed disease may have an underlying germline alteration that will distinguish the behavior of the cancer and inform some of the treatment. Certain clinical characteristics may also help with treatment planning.

Beyond genomic markers, there is a lot of interest in biomarkers, although they do not seem to have an impact on treatment decisions, says Quinn. Nonetheless, there are several proofs of principle related to different therapies that are starting to emerge, he adds.

David I. Quinn, MD, MBBS, PhD, FRACP, FACP

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Dr. Quinn on Novel Hormonal Therapies in Prostate Cancer

Dr. Quinn on the Biology of RCC