Chemotherapy - August 2020

This issue marks a new era for this publication as it is the first to be published under the NASPCC umbrella. We anticipate that this will allow us to reach a much larger audience.

 As an old hand in the field, it is very gratifying to see the steady stream of high-quality clinical trials define the best treatment options for those with advanced disease. The good news is that, for most patients with advanced disease, you and your physician have a range of options so that treatment can be tailored to your situation.

For patients with newly diagnosed metastatic prostate cancer, a vast majority of patients should no longer be treated solely with testosterone suppressing agents, such as LHRH agonists like Lupron (leuprolide). Instead, they should receive these agents combined with either Taxotere (docetaxel) or one of the newer androgen antagonists, such as Xtandi (enzalutamide). Indeed, the literature on cytotoxic chemotherapies, like Taxotere (docetaxel), is so intertwined with anti-androgens that these hormonal agents occupy a considerable portion of this issue. This serves patient interests well, as many will need to discuss anti-androgens as an alternative to chemotherapy. This issue is information-dense and it is not practical to highlight all of the key points in this introduction. Instead, I would like to highlight two relatively new drugs that look as if they might have a major impact. The first is Nubeqa (darolutamide), which is FDA-approved and in the same drug family as Xtandi (enzalutamide) and Erleada (apalutamide). The latter two cross the blood-brain barrier (BBB) and can impair brain function and can be associated with seizures. Nubeqa (darolutamide) does not cross the BBB and is much less likely to cause central nervous system toxicity (CNST). The second drug is Relumina (relugolix), an oral drug that blocks the production of testosterone much more effectively than Lupron (leuprolide). In comparison, Relumina (relugolix) has a lower risk of cardiovascular events, but it is not yet approved for the treatment of prostate cancer.

Each of our interviewees discusses the impact of the Novel Coronavirus on the management of prostate cancer patients. The good news is that, with proper precautions, it is possible to give chemotherapy safely despite the pandemic.

Charles E. Myers, Jr., MD

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