cáncer de próstata avanzado - basesbiologicascancer.com · 6 retrospective series 166 26-55% -...

Cáncer de Próstata AvanzadoAlgoritmo terapéutico global

Rebeca Lozano MejoradaUnidad de Investigación Clínica en Cáncer de Próstata,

Centro Nacional de Investigaciones Oncológicas (CNIO)

Unidad Tumores Genitourinarios, CNIO-IBIMA

DISCLOSURES

Speaker fees: Roche, Janssen-Cilag, Bayer

Travel/acommodation: Roche, Astellas Pharma, Sanofi

Research Grant (institution): Bayer, Janssen-Cilag

1940s 1996

ADT

DocetaxelTAX327

SWOG 9916

MitoxantroneCALGB 9182

Sipuleucel TIMPACT

CabazitaxelTROPIC

AbirateroneCOU-AA-301

EnzalutamideAFFIRM

AbirateroneCOU-AA-302

EnzalutamidePREVAIL

Radium-223ALSYMPCA

EnzalutamidePROSPER

ApalutamideSPARTAN

DocetaxelCHAARTEDSTAMPEDE

AbirateroneLATITUDE

STAMPEDE

2004 2010 2011 2012 2013 2014 2017 20182015 2016 2019

DarolutamideARAMIS

Radiotherapy (low-volume)

STAMPEDE

TIMELINE PROSTATE CANCER

ADVANCED PROSTATE CANCER

ClinicallyLocalizedDisease

RisingPSA

Noncastrate

nmCRPC

mCRPC:1stline

mCRPC:2ndline

mCRPC:LineX

ClinicalMetastases:Noncastrate

Non-metastatic castration-resistant prostate cancer

Hormone-näive metastaticprostate cancer

Metastatic castration-resistantprostate cancer

Scher et al. J Clin Oncol 2016;34:1402-1418.

AbirateroneEnzalutamide

DocetaxelCabazitaxelRadium-223

Docetaxel / Cabazitaxel Abiraterone

Enzalutamide, Apalutamide, Darolutamide

Radium-223


NOS

(exp)OS

(control)△OS HR RECIST Resp PSA Resp

DocetaxelTAX-327

1006 18,9 m 16,5 m 2,4 m 0,76 12% vs 7% 45% vs 32%

CabazitaxelTROPIC

755 15,1 m 12,7 m 2,4 m 0,70 14.4% vs 4.% 39% vs 18%

AbirateronaCOU-301

1195 15,8 m 11,2 m 3,4 m 0,74 14,8% vs 3,3% 29,5% vs 6%

EnzalutamideAFFIRM

1199 18,4 m 13,6 m 4,8 m 0,63 29% vs 4% 54% vs 2%

Radium-223 ALSYMPCA

921 14,9 m 11,3 m 3,6 m 0,70 - 16% vs 6%

AbirateroneCOU-302

1088 34,7 m 30,3 m 4,4 m 0,81 36% vs 16% 62% vs 24%

EnzalutamidePREVAIL

1717 32,4 m 30,2 m 2,2 m 0,71 59% vs 5% 78% vs 3%

Sym

pto

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inim

ally

sym

pto

mat

ic


Metastatic CRPC

Median PFS:4.4m (C20); 5.1m (C25); 5.3m (D75)

Median OS:24.5m (C20); 25.2m (C25); 24.3m (D75)

Oudard et al. J Clin Oncol 2017;35(28):3189-3197.

N=1168

mCRPC, treatment naïve

Only 1.9% of patients had received previous abi or enzaDocetaxel as 1st treatment line


Cabazitaxel 20 mg/m2

Cabazitaxel 25 mg/m2

Docetaxel 75 mg/m2

Khalaf D et al, Poster Session june 2, abs 5015

Annala et al. Cancer Discov 2018;8(4):444-57. Khalaf et al. ASCO 2018; Abstract 5015


Abiraterone vs Enzalutamide

Phase II trial

COU-301COU-302

AFFIRMPREVAIL

TreatmentDeliveredandPatientDisposition

95Patients

R

ARMA(N=45)Cabazitaxel

MedianCycles=9(1-32)

ARMB(N=50)ABI(N=27)orENZA(N=23)


Didnotcross-over(N=21)● Onstudy(N=7)● Progression(N=4)● Patientwithdrawal(N=4)● Toxicity(N=4)● Other(N=2)

N=24ABIorENZA

N=30Cabazitaxel

Onstudy(n=5)Discontinuedtreatment(n=19)● Progression(n=17)● Other(n=2)

Onstudy(n=7)Discontinuedtreatment(n=23)● Progression(n=16)● Patientwithdrawal(n=3)● Toxicity(n=2)● Other=2

Didnotcross-over(N=20)● Onstudy(N=8)● Progression(N=8)● Patientwithdrawal(N=2)● AlternateTreatment(N=1)● Other(N=1)

Crossover

Adverse prognosis population

• Liver metastases• CRPC within 12m of ADT • At least 4 of: LDH > ULN, ECOG PS 2, visceral mts,

Albumin < 4 g/dL, ALP > ULN, < 36m of ADT

PSADeclineOn-Treatment

ArmACabazitaxel

ArmBAbirateroneorEnzalutamide

P-value

PSADecline≥30% 33/44(75%) 34/50(68%) 0.500

PSADecline≥50% 25/44(57%) 30/50(60%) 0.835

NoPSADecline 5/44(11%) 11/50(22%) 0.271

Chi et al. ESMO 2018. Abstract 792O


Abi / Enza vs Cabazitaxel

Phase II trial

Cross-resistance Abiraterone - Enzalutamide

Placebo + Abiraterone

Enzalutamide + Abiraterone

Open labelEnza

No PSA prog at wk 13 & 21

At PSA prog:

PLATO trial

Abi post-Enza Enza post-Abi

Open labelAbi

At prog:

At least 24 wksof treatment

Enzalutamide

Abi post-EnzaEnza post-Abi

Attard et al. J Clin Oncol 2018;36(25): 2639-2646. De Bono et al. Eur Urol 2018;74(1):37-45

Abi→ Enza PREVAILEnza → Abi

(PLATO)COU-302

N 145 872 251 546

PSA response 26% 78% 2% 68%

PSA-PFS 5.7 m 11.2 m 2.8 m 11.1 m

rPFS 8.1 m 20 m 7 m 16.5 m

PFS - - 5.6 m -

OS 35.3 m - 34.7 m


The first-line…does affect the efficacy of subsequent treatment lines?




Khalaf et al. ASCO 2018; Abstract 5015



Cross-resistance Abiraterone - Enzalutamide

Abi2nd line

Enza 2nd line

P-value

PSA 50% 3 (4%) 20 (31%) <0.001

Thadani-Mulero et al. Cancer Res 2011; 72 (18):4611-4615


Cross-resistance Abiraterone/Enzalutamide - Docetaxel

OSPFSResp RxResp PSAN

12.5 m4.4 - 5.1-26-55%1666 retrospective series

13.6 m--45%314Docetaxel without Abiraterone

outside of clinical trials

19.2 mNR12%52.4%1006TAX-327

Mezynski et al. Ann Oncol 2012; Suzman et al. Prostate 2014; Schweizer et al. Eur Urol 2014; Azad et al. ASCO GU 2014; Zhang et al. Clin GU Cancer 2015;

Aggarwal et al. Clin GU Cancer 2014; Templeton et al. Ann Oncol 2013; Berthold et al. J Clin Oncol 2008; de Bono et al Eur Urol 2017

Docetaxel post-abiraterone in COU-302 subjects

• 40% PSA response• Median treatment: 4,2 months


Cross-resistance Abiraterone/Enzalutamide - Docetaxel


8.2 – 20.3 m4.5 - 5.5 m14-15%31-41%2865 retrospective series

15.1 m2.8 m14.4%39.2%755TROPIC

Van Soest et al. Eur Urol 2015; 67: 981-985;Sella A. Clin Genitourina Cancer 2014. 12(6):428-32; Al Nakouzi N, Eur Urol 2015. 68(2): 228-35; Pezaro CJ. Eur Urol 2014. 66(3):459-65; Caffo O et

al. Eur Urol 2015. 68(1):147-53; Sonpavde G et al. Clin Genitoruna Cancer 2015. 13(4).309-318; de Bono JS et al. Lancet 2010. 376(9747): 1147-54.


Cross-resistance Abiraterone/Enzalutamide - Cabazitaxel

Chi et al. ESMO 2018. Abstract 792O


TreatmentDeliveredandPatientDisposition

95Patients

R

ARMA(N=45)Cabazitaxel


ARMB(N=50)ABI(N=27)orENZA(N=23)


Didnotcross-over(N=21)● Onstudy(N=7)● Progression(N=4)● Patientwithdrawal(N=4)● Toxicity(N=4)● Other(N=2)

N=24ABIorENZA

N=30Cabazitaxel

Onstudy(n=5)Discontinuedtreatment(n=19)● Progression(n=17)● Other(n=2)

Onstudy(n=7)Discontinuedtreatment(n=23)● Progression(n=16)● Patientwithdrawal(n=3)● Toxicity(n=2)● Other=2

Didnotcross-over(N=20)● Onstudy(N=8)● Progression(N=8)● Patientwithdrawal(N=2)● AlternateTreatment(N=1)● Other(N=1)

Crossover


8.2 – 20.3 m4.5 - 5.5 m14-15%31-41%2865 retrospective series

15.5 m4.3 m-36%30Prospective Data

15.1 m2.8 m14.4%39.2%755TROPIC

Cross-resistance Abiraterone/Enzalutamide - Cabazitaxel

Previous Docetaxel14,4 vs 11,3 m; HR: 0,70 (p=0.002)

No previous Docetaxel16,1 vs 11,5 m; HR: 0,69 (p=0.01)

Hoskin P et al. Lancet Oncol 2014; Sartor et al. Prostate 2016


Cross-resistance with Radium-223?

PROGNOSTIC BIOMARKERS

Clinical trial stratification

Individual prognosis estimation (nomograms)

No proven value for treatment selection

AgeGleason ScoreVisceral metastasesPainTime on ADT

CLINICAL BIOMARKERS

PSA, LDH, ALP, AlbuminNLRCTCs

ANALYTICAL BIOMARKERS


How do we decide the sequence in our clinical daily practice?

Docetaxel TAX-327

Neuropathy: 32% vs 10%Neutropenia: 32% vs 22%

Febrile neutropenia: 3% vs 2%Diarhea: 32% vs 10%

Other: asthenia, alopecia (65%), nail toxicity (30%), disgeusia

(18%), mucositis (20%), peripheraledema (19%)

Cabazitaxel TROPIC

Neutropenia: 82% vs 58%Febrile neutropenia: 8% vs 1%

Diarrea: 47% vs 11% (G3: 6% vs <1%)

Neuropathy: 14% vs 3%

Abiraterone COU-301

Fluid retention: 31% vs 22%Hypokalemia: 17% vs 8%

Transaminase elevation: 10% vs 8 %Diarrea: 18% vs 14%

Neutropenia: 1% vs 1%Anemia: 23% vs 26%

Cardiac events: 13% vs 11%

Radium-223 ALSYMPCA

Diarrhea: 25% vs 15% (G3: 2% vs 2%)

Febrile neutropenia: 1% vs 1%Anemia: 31% vs 31%(G3-4: 13% vs 13%)

Thrombocytopenia: 12% vs 6%

No increase in secondary tumors

Enzalutamide AFFIRM

Astenia: 34% vs 29%Epilepsy (5 cases)

Diarrhea: 21% vs 18%Cardiac events: 6% vs 8%

NEUROCOGNITIVE TOXICITY

Courtesy Dr David Lorente



Real life??

Castro et al. JCO 2019; Lozano et al. ASCO GU 2019. Abstract 264

Allpatients

(N=406)

Firstline

Docetaxel

(N=188)

Firstline

Abi/Enza

(N=218)

p-value

MedianageatmCRPC,years(range) 71.6 69.9 73.3 <0.001

Age≥75years 136(33.5%) 48(25.5%) 88(40.4%) 0.002

Gleason≥8 237(59.1%) 115(61.2%) 122(57.3%) 0.429

StageIVatdiagnosis 192(47.3%) 98(52.1%) 94(43.1%) 0.070

Localtherapy

No 198(48.9%) 96(51.1%) 102(47%) 0.828

Radiotherapy 113(27.9%) 51(27.1%) 62(28.6%)

Surgery 69(17%) 31(16.5%) 38(17.5%)

Surgery+Radiotherapy 25(6.2%) 10(5.3%) 15(6.9%)

Visceraldisease 52(12.8%) 33(17.6%) 19(8.7%) 0.008

ECOGPerformanceStatus

0 179(44.5%) 68(36.4%) 111(50.9%) 0.012

1 195(48.1%) 104(55.6%) 91(41.7%)

2 31(7.7%) 15(8%) 16(7.3)

ElevatedALP(>ULN) 186(45.8%) 98(52.1%) 88(40.4%) 0.018

ElevatedLDH(>ULN) 158(39%) 90(48.1%) 68(31.2%) <0.001

Hemoglobin<10g/dL 20(4.9%) 14(7.4%) 6(2.8%) 0.029

Albumin<3.5g/dL 31(7.7%) 21(11.3%) 10(4.6%) 0.012

Real Life???

Castro et al. JCO 2019; Lozano et al. ASCO GU 2019. Abstract 264

Choice of 1st line agent was not associatedwith OS in the MV model


10,8 vs 8,3 m; HR: 0,50 (p<0.001)

31,3 vs 29,9 m; HR: 1,05 (p<0.725)


Can we improve outcomes combining agents?

Enzalutamide + Abiraterone

• mCRPC• Taxanes naïve• Abi/Enza naïve

Enzalutamide 160 mg / 24 h

Enzalutamide 160 mg /24 + Abiraterone 1.000 mg / 24h + Prednisone

N=1168

Enza PREVAIL

N 657 872

PSA response 80% 78%

OS 33.6 m 35.3 m

AE Grade 3-5 55.6% 43%

Treat Discont 5% 6%

Morris Jm et al ASCO 2019. Abstract 5008

Enza Enza + Abi PREVAIL

N 657 654 872

PSA response 80% 76.5% 78%

OS 33.6 m 32.7 m 35.3 m

AE Grade 3-5 55.6% 68.8% 43%

Treat Discont 5% 13% 6%

ERA-223 Trial

• mCRPC• ≥2 bone mts• Chemo naïve• Asymptomatic/mildly

symptomatic

Abiraterone 1.000 mg / 24h + Ra-223 50 kBq/kg x 6 cycles

Abiraterone 1.000 mg / 24h + Placebo

No significant improvement in SSE-PFS with the combination

No significant improvement in OS with the combination

Smith et al. Lancet Oncol 2019


TEAEs in ≥15% of patients in either group, n (%)

AAP + radium-223N=392

AAP + placeboN=394

All Grade 3 Grade 4 All Grade 3 Grade 4

Back pain 133 (34) 23 (6) 0 121 (31)* 16 (4) 0

Fatigue 89 (23) 4 (1) 0 79 (20) 6 (2) 0

Arthralgia 80 (20) 4 (1) 0 75 (19) 5 (1) 0

Fracture† 103 (26) 35 (9) 1 (0.3) 38 (10)* 12 (3) 0

Hypertension 59 (15) 43 (11) 0 78 (20) 51 (13) 1 (0.3)

ALT increased 69 (18) 29 (7) 5 (1) 59 (15) 28 (7) 0

Constipation 56 (14) 1 (0.3) 0 72 (18) 0 0

Diarrhea 65 (17) 4 (1) 0 60 (15) 7 (2) 0

Nausea 66 (17) 1 (0.3) 0 59 (15) 1 (0.3) 0

AST increased 61 (16) 18 (5) 1 (0.3) 53 (14) 16 (4) 0

Peripheral edema 51 (13) 2 (0.5) 0 61 (16) 0 0

Anaemia 57 (15) 24 (6) 0 46 (12) 11 (3) 0

Increased risk of fractures in the combination arm, especially in patients not receivingZA/denosumab


Smith et al. Lancet Oncol 2019

30 Churchill Place ● Canary Wharf ● London E14 5EU ● United Kingdom

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Telephone +44 (0)20 3660 6000 Facsim ile +44 (0)20 3660 5555

Send a quest ion via our w ebsite www.ema.europa.eu/contact

© European Medicines Agency, 2018. Reproduction is authorised provided the source is acknowledged.

13 July 2018

EMA/472321/2018

PRAC recommends restricting use of prostate cancer

medicine Xofigo Medicine should only be used after two previous treatments or when other

treatments cannot be taken

EMA’s safety committee PRAC has recommended restricting the use of the cancer medicine Xofigo

(radium-223 dichloride) to patients who have had two previous treatments for metastatic prostate

cancer (prostate cancer that has spread to the bone) or who cannot receive other treatments.

These restrictions follow a review of data from a study suggesting that patients given Xofigo seemed to

be at risk of dying earlier and had more fractures than patients given placebo (a dummy treatment).

The study included patients with no or only mild symptoms, whereas Xofigo is only authorised in

patients with symptoms. In the study, patients given Xofigo with Zytiga (abiraterone acetate) and

prednisone/prednisolone died on average 2.6 months earlier than those given placebo with Zytiga and

prednisone/prednisolone. In addition, 29% of patients who received the Xofigo combination had

fractures, compared with 11% of patients given placebo.

It is thought that Xofigo, which is taken up by the bone, accumulates at sites where the bone is

already damaged, for example by osteoporosis or micro-fractures, increasing the risk of fracture.

However, the reasons for a possible earlier death in this study are not fully understood.

The PRAC also confirmed its previous interim recommendation that the medicine must not be used with

Zytiga and prednisone/prednisolone.

Xofigo should not be used with other systemic cancer therapies, except for treatments to maintain

reduced levels of male hormone (hormone therapy). The medicine should not be used in patients who

have no symptoms, in line with the current indication, nor in those with a low number of bone

metastases called osteoblastic bone metastases.

Patients should be carefully assessed for their risk of fractures before, during and after treatment.

Preventive measures such as the use of bisphosphonates or denosumab as agents to increase bone

strength should be considered before starting or resuming treatment with Xofigo.

The company marketing Xofigo is requested to conduct studies to investigate, in particular, the

mechanisms responsible for the possible risk of earlier death and the increased risk of fractures

reported in the study. The benefits and risks of Xofigo in the restricted indication should also be further

characterised.




Send a quest ion via our w ebsite www.ema.europa.eu/contact


13 July 2018 EMA/472321/2018





























characterised.

https://www.ema.europa.eu/documents/referral/xofigo-article-20-procedure-prac-recommends-restricting-use-prostate-cancer-medicine-xofigo_en.pdf




Send a quest ion v ia our w ebsite www.ema.europa.eu/contact


13 July 2018 EMA/472321/2018





























characterised.


Heinrich D, Clin Genitourin Cancer, 2017



RisingPSA

Noncastrate

nmCRPC

mCRPC:1stline

mCRPC:2ndline

mCRPC:LineX





AbirateroneDocetaxel

RadiotherapyEnzalutamideApalutamide



N OS (exp)

OS(control)

△OS HR (IC95%)

CHAARTED

All pts (M1) 790 57,6 m 44 m 13,6 m 0.61 (0.47-0.80)

High Volume 513 49.2 m 32.2 m 17 m 0.60 (0.45-0.81)

Low Volume 277 63.5 NR - 1.04 (0.70-1.55)

STAMPEDE -Docetaxel

All pts (M1 + High risk M0) 1776 81 m 71 m 10 m 0.78 (0,66-0,93)

M1 1087 65 m 43 m 22 m 0.73 (0.59-0.89)

STAMPEDE -Abiraterone

All pts (M1 + High risk M0) 1917 - - - 0.63 (0.52-0.76)

M1 patients 1002 - - - 0.61 (0.49-0.75)

LATITUDE All pts (High risk M1) 1199 53,3 m 36,5 m 16,8 m 0.66 (0.56-0.78)

Sweeney et al. N Engl J Med 2015;373:737–746. James et al. Lancet 2016;387:1163–1177 James et al. N Engl J Med 2017;377:338–351. Fizazi et al. N Engl J Med 2017;377:353–360. Hoyle ESMO 2018; Fizazi et al. Lancet Oncol 2019.20(5):686-700.

CHAARTED Low CHAARTED High

LATITUDE Low 333 (37%) 95 (10,5%)

LATITUDE High 69 (7,7%) 404 (44,8%)

18,2% would be classified differently!!


Metastatic HSPC

Sydes et al. Ann Oncol 2018;29(5):1235-48

Direct comparison of 566 pts included between Nov 2011 and Mar 2013


Summary

Strong evidence favouring AAP

Toxicity profiles quite different and well known

Weak evidence favouring AAP

No good evidence of a difference

FavoursSOC+AAP

FavoursSOC+DocP

Hazard ratio

Metastatic progression-free

survival

Progression-free survival

Failure-free survival

Symptomatic skeletal events

Cause-specific survival

Overall survival

Head-to-head data in 566 pts (Nov-2011 to Mar-2013)

Proportionately different time spent in each disease state

Sydes et al. Ann Oncol 2018;29(5):1235-48

Direct comparison of 566 pts included between Nov 2011 and Mar 2013

HR (95%CI) P-valInteractn

test

All 1.16 (0.82 to 1.65) 0.40

M0 1.51 (0.58 to 3.93) 0.400.69

M1 1.13 (0.77 to 1.66) 0.53

Key:HR<1 favours SOC+AAPHR>1 favours SOC+DocP

Interactn = test for interaction (heterogeneity of treatment effect)

SOC+DocP SOC+AAP

Events Pts Events Pts

All 44 189 105 377

M0 6 74 16 150

M1 38 115 89 227

SOC+AAP

SOC+DocP

Overall survival [primary outcome measure]


Docetaxel

Abiraterone

Sydes et al. Ann Oncol 2018;29(5):1235-48. Morgans et al. J Clin Oncol 2018;36(11): 1088-95.



N OS (exp)

OS(control)

△OS HR (IC95%)

CHAARTED

All pts (M1) 790 57,6 m 44 m 13,6 m 0.61 (0.47-0.80)

High Volume 513 49.2 m 32.2 m 17 m 0.60 (0.45-0.81)

Low Volume 277 63.5 NR - 1.04 (0.70-1.55)

STAMPEDE -Docetaxel

All pts (M1 + High risk M0) 1776 81 m 71 m 10 m 0.78 (0,66-0,93)

M1 1087 65 m 43 m 22 m 0.73 (0.59-0.89)

STAMPEDE -Abiraterone

All pts (M1 + High risk M0) 1917 - - - 0.63 (0.52-0.76)

M1 patients 1002 - - - 0.61 (0.49-0.75)

LATITUDE All pts (High risk M1) 1199 53,3 m 36,5 m 16,8 m 0.66 (0.56-0.78)

Metastatic HSPC

N OS 3year(exp)

OS 3year(control)

HR (IC95%)

STAMPEDE -Radiotherapy

All pts (Low&High Volume) 2061 65% 62% 0.92 (0,80-1,06)

Low volume 819 81% 73% 0.68 (0.52-0.90)

Parker C et al. Lancet Oncol 2019



RisingPSA

Noncastrate

nmCRPC

mCRPC:1stline

mCRPC:2ndline

mCRPC:LineX






EnzalutamideApalutamideDarolutamide





NMFS (exp)

MFS(control)

△MFS HR PFS PFS2 TTPP

ApalutamideSPARTAN

1207 40,5 m 16,2 m 24,3 m 0,28 40.5 vs 14,7 m NR vs 39 m NR vs 3,7 m

EnzalutamidePROSPER

1401 36,6 m 14,7 m 21,9 m 0,29 - - 37,2 vs 3,9 m

DarolutamideARAMIS

1509 40,4 m 18,4 m 22 m 0,41 36,8 vs 14,8 m - 33,2 vs 7,3 m

High risk: PSADT < 10 months


Non-Metastatic CRPC

Absence of metastases on conventional imaging

Smith M et al NEJM 2018; Hussain M et al, NEJM 2018; Fizazi K et al, NEJM 2019

Many of the patients would have had metastases according to more sensitive imaging test


Low penetration of the blood-brain barrer

Higani C, Nature Reviews, 2019

Enzalutamide Apalutamide Darolutamide

AE Grade 3-4 31% vs 23% 45,1% vs 34,2% 24,7% vs 19,5%

Treatmentdiscontinuation

9% vs 6% 10,6% vs 7% 8,9% vs 8,7%



RisingPSA

Noncastrate

nmCRPC

mCRPC:1stline

mCRPC:2ndline

mCRPC:LineX






EnzalutamideApalutamideDarolutamide





Our decisions are not based on thebiology of the disease


Actionable alterations in 89% of mCRPC patients

AR pathway: 62.7%

PI3k-Akt-mTOR pathway: 62.7%

DNA repair pathway: 20%

Genomic rearrangements: 55-60%

Robinson et al. Cell 2015;161:1215-28

Molecular biology

BIOMARKERS !!

• El tratamiento del Cáncer de Próstata Avanzado ha evolucionado rápidamente en los últimos años

• No disponemos de la secuencia óptima de tratamiento

- Ningún fármaco ha demostrado eficacia superior en primera línea (head-to-head)

- Beneficio similar con diferente perfil de toxicidad

- En siguientes líneas considerar resistencias cruzadas

- Las decisiones deben ser tomadas de manera individual

• Actualmente debemos considerar multitud de factores: síntomatología, perfiles de toxicidad, preferencias paciente / médico, etc.

• El desarrollo adecuado de biomarcadores es esencial para avanzar hacia una medicina de precisión.

CONCLUSIONES

Prostate Cancer Clinical Research Unit

David Olmos

Nuria Romero

María Pacheco

Leticia Rivera

Gala Grau

Paz Nombela

Lorena Magraner

Benjamin Olmos

Carlo Cattrini

Ana Gutierrez

Elena Castro

Isabel Aragón

Ylenia Cendón

Mónoca Balsells

Francesca Vitrone

Teresa Garcés

Carles Moreno

Fernado Lopez-

Campos

David Lorente

THANK YOU!

cáncer de próstata avanzado - basesbiologicascancer.com · 6 retrospective series 166 26-55% -...

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