Applying treatment advances in castration-resistant prostate cancer: The influence of serial digital education on the uro-oncology team.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 20-20
Author(s):  
Tariqa Ackbarali ◽  
Wendy Turell ◽  
Elizabeth L. del Nido ◽  
Neal D. Shore
Keyword(s):  
Prostate Cancer ◽  
Adverse Event ◽  
Treatment Options ◽  
Parp Inhibitors ◽  
Castration Resistant Prostate Cancer ◽  
Event Management ◽  
Castration Resistant ◽  
Adverse Event Management ◽  
Biomarker Testing ◽  
Behavioral Impact

20 Background: Improvements in the understanding of prostate tumor development have spurred advances in biomarker testing and new therapies for prostate cancer, providing clinicians with expanded testing and treatment options. However, these changes have led to competence gaps regarding the use of biomarker testing, integration of PARP inhibitors, application of new data for nmCRPC and mCRPC, and adverse event management. To address these needs, a serial educational initiative was designed for the urology-oncology team. Methods: A 4-part CE activity was launched live-online in December, 2020, and remains on-demand through December, 2021 at UroCareLive.com and OMedLive.com. The activity was launched in partnership with Large Urology Group Practice Association (LUGPA) and included case presentations, live polling, and Q&A. Knowledge and competence questions were administered pre-activity, immediate post-activity, and 2-months post-activity. Patient and clinical practice-impact questions were also asked at the 2-month follow-up. Data from these questions were analyzed to determine engagement and clinical impact. Results: To date, 761 clinicians have participated in the activity. All 12 CE test questions reflected improvements in knowledge and competence, 11 of which were statistically significant. Questions focused on: genomic testing, biomarker analysis, recent clinical trial study results, newly approved therapies, and adverse event management. At 2-mos. follow-up, 70% reported improved behavioral impact on clinical practice and 63% reported impact on patient experience and outcomes. Clinicians provided write-in examples of these changes, illustrating improvements in patient-reported satisfaction, genetic testing, and use of newer therapies, including PARP inhibitors. Practice pattern questions pertaining to biomarker testing and the use of emerging therapies showed the majority of post-program respondents (42%) preferred to utilize blood/serum-based biomarker tests for their patient vs urine- or tissue-based tests. The greatest reported challenges to biomarker testing were affordability (30%) and lack of guideline clarity (23%). The top 2 barriers to adoption of new agents were reported as lack of awareness and lack of experience (32% and 20%, respectively). Conclusions: The activity successfully improved uro-oncology team knowledge of genetic testing and newer therapies to manage castration-resistant prostate cancer. Learners demonstrated significant improvements in competence concerning biomarker testing, treatment personalization, and adverse event management. Open-ended responses to behavioral impact questions illustrated improvements in biomarker usage, application of newer therapies, and confidence in patient counseling regarding treatment options.

scholarly journals Novel therapies are changing treatment paradigms in metastatic prostate cancer

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Eric Powers ◽  
Georgia Sofia Karachaliou ◽  
Chester Kao ◽  
Michael R. Harrison ◽  
Christopher J. Hoimes ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Treatment Options ◽  
Parp Inhibitors ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Damage Repair ◽  
Systemic Treatments ◽  
Terminal Diagnosis ◽  
Specific Membrane ◽  
Repair Genes

Abstract Metastatic castration-resistant prostate cancer (mCRPC) remains a terminal diagnosis with an aggressive disease course despite currently approved therapeutics. The recent successful development of poly ADP-ribose polymerase (PARP) inhibitors for patients with mCRPC and mutations in DNA damage repair genes has added to the treatment armamentarium and improved personalized treatments for prostate cancer. Other promising therapeutic agents currently in clinical development include the radiotherapeutic 177-lutetium-prostate-specific membrane antigen (PSMA)-617 targeting PSMA-expressing prostate cancer and combinations of immunotherapy with currently effective treatment options for prostate cancer. Herein, we have highlighted the progress in systemic treatments for mCRPC and the promising agents currently in ongoing clinical trials.

scholarly journals 633 Incorporating checkpoint inhibitors into cancer care: a study of the impact of digital education on clinical competence and practice patterns

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A663-A663
Author(s):  
Tariqa Ackbarali ◽  
Elizabeth del Nido ◽  
Brian Rini ◽  
Michael Overman ◽  
Ignacio Witsuba
Keyword(s):  
Adverse Event ◽  
Positive Impact ◽  
Checkpoint Inhibitors ◽  
Survivorship Care ◽  
Event Management ◽  
Adverse Event Management ◽  
Biomarker Testing ◽  
Patient Prognosis ◽  
Behavioral Impact

BackgroundImmune checkpoint inhibitors have transformed the treatment landscape for a variety of tumors and have significantly improved patient prognosis and longevity. Evolving practice standards for diagnostic testing and extensive emerging clinical trial data have left clinicians challenged to apply newer treatments in practice and manage associated side effects. Additionally, improved patient prognosis has created a greater need for survivorship care plans; clinicians must be able to tailor plans to the needs of patients treated with these agents. Education pertaining to biomarker testing, applications of checkpoint inhibitors, adverse event management, and survivorship care is critical to ability to improve patient experience and quality of life.MethodsA 4-hour CME activity was broadcast live-online in June, July, and August 2020 and remained on-demand through February 2021 at OMedLive.com. The program was provided in partnership with the Society for Immunotherapy in Cancer (SITC). The initiative was divided into themes including biomarker usage for checkpoint inhibitor selection, adverse event management, survivorship care, and use of checkpoint inhibitors and combination therapies in the metastatic setting. Knowledge and competence questions were administered pre-, immediate post-, and 2 mos. post-activity. Behavioral impact questions were also asked at follow-up. Data from these questions were analyzed to determine engagement and clinical impact.ResultsFinal program results from 1,909 learners showed that post-activity engagement resulted in 61% reporting a positive impact on patient experience, and 74% reporting a positive impact on clinical practice, with 179 qualitative write-in examples detailing improvements in diagnosis, use of newer therapies, ability to manage adverse events, and patients' tolerance of treatments. All 14 CME test questions reflected statistically significant improvements on biomarker utility, checkpoint inhibitors, combination therapy applications, adverse event management, and survivorship care, with an average of 15% pre to 2-month follow-up improvement. The overall average effect size from pre- to post-test was d = 1.27, and d = 0.429 for pre- to 2-month follow-up point. Practice pattern questions elucidated preferences for biomarker testing, challenges of integrating immunotherapy, areas of difficulty in survivorship care, and challenges enrolling in clinical trials.ConclusionsThe activity was successful in improving clinician understanding of the use of biomarker testing to determine treatment plans, applications of checkpoint inhibitors and combination therapies, adverse event management, and survivorship care planning. Open-ended responses to behavioral impact questions illustrated clear improvements in clinician-reported patient impacts, including improved psychological tolerance of treatment, quality of life, and overall wellness.

scholarly journals Recent Developments in the Management of Advanced Prostate Cancer

2020 ◽  
Vol 18 (7.5) ◽  
pp. 969-972
Author(s):  
Sandy Srinivas
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Treatment Options ◽  
Parp Inhibitors ◽  
Cross Resistance ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Recent Developments ◽  
Emerging Treatments ◽  
Localized Disease

Numerous new options are available for the treatment of prostate cancer when it progresses beyond localized disease. Older drugs, first developed for treatment of metastatic castration-resistant prostate cancer (CRPC), are being used to treat nonmetastatic disease based on results of large randomized controlled trials. Sequencing of available treatment options is challenging for CRPC, but there is some guidance from trial data. Cross-resistance among newer hormonal drugs is a concern, and therefore switching to another class of drug is preferred. Emerging treatments on the horizon, such as PARP inhibitors in patients with BRCA2 mutations and lutetium-177 in those with prostate-specific membrane antigen (PSMA)–positive disease, may look promising to improve outcomes among those with advanced prostate cancer.

Treatment Given Near the End of Life in Castration-Resistant Prostate Cancer

2012 ◽  
Vol 29 (7) ◽  
pp. 536-540 ◽  
Author(s):  
Hanna A. Zaghloul ◽  
Jose R. Murillo
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
End Of Life ◽  
Treatment Options ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Related Quality ◽  
Impact On Survival ◽  
New Treatments

Chemotherapy treatment options are limited for patients with castration-resistant prostate cancer (CRPC). The purpose of this study is to report treatment use and adverse effects (AEs) within the last three months of life in patients with CRPC. Of the 88 patients identified, 32% received treatment within 3 months of death, and documented AEs occurred in 25% of patients. Of those, neutropenia (18.3%), nausea/vomiting (18.3%), and febrile neutropenia (13.6%) were the most frequent. Results of this study show high treatment utility towards the end-of-life in patients with CRPC, with one fourth of patients experiencing AEs. Attention to health-related quality of life becomes increasingly important as new treatments appear to have small impact on survival, and AEs of those treatments may significantly impact patient quality of life.

scholarly journals BRCA Mutations in Prostate Cancer: Prognostic and Predictive Implications

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Carlo Messina ◽  
Carlo Cattrini ◽  
Davide Soldato ◽  
Giacomo Vallome ◽  
Orazio Caffo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Parp Inhibitors ◽  
Castration Resistant Prostate Cancer ◽  
Brca Mutations ◽  
Primary Tumors ◽  
Receptor Signalling ◽  
Castration Resistant ◽  
Damage Repair ◽  
Poor Outcomes

Despite chemotherapy and novel androgen-receptor signalling inhibitors (ARSi) have been approved during the last decades, metastatic castration-resistant prostate cancer (mCRPC) remains a lethal disease with poor clinical outcomes. Several studies found that germline or acquired DNA damage repair (DDR) defects affect a high percentage of mCRPC patients. Among DDR defects, BRCA mutations show relevant clinical implications. BRCA mutations are associated with adverse clinical features in primary tumors and with poor outcomes in patients with mCRPC. In addition, BRCA mutations predict good response to poly-ADP ribose polymerase (PARP) inhibitors, such as olaparib, rucaparib, and niraparib. However, concerns still remain on the role of extensive mutational testing in prostate cancer patients, given the implications for patients and for their progeny. The present comprehensive review attempts to provide an overview of BRCA mutations in prostate cancer, focusing on their prognostic and predictive roles.

scholarly journals Clinical Development of PARP Inhibitors in Treating Metastatic Castration-Resistant Prostate Cancer

Cells ◽  
2019 ◽  
Vol 8 (8) ◽  
pp. 860 ◽  
Author(s):  
Jacob J. Adashek ◽  
Rohit K. Jain ◽  
Jingsong Zhang
Keyword(s):  
Prostate Cancer ◽  
Unmet Need ◽  
Parp Inhibitors ◽  
Phase Iii ◽  
Clinical Activity ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Phase Ii Studies ◽  
Phase Iii Trials ◽  
Signaling Inhibitors

The approval of upfront abiraterone for castration-sensitive prostate cancer and the approval of enzalutamide and apalutamide for non-metastatic castration-resistant prostate cancer have led to early utilization of potent androgen receptor (AR) signaling inhibitors in treating advanced prostate cancer. There is an unmet need to develop novel therapies beyond targeting AR signaling for metastatic castration-resistant prostate cancer (mCRPC). Poly (ADP-ribose) polymerase inhibitors (PARPi) belong to a class of targeted agents being developed for the treatment of homologous recombination repair (HRR) deficient tumors. Olaparib, rucaparib, niraparib, veliparib, and talazoparib were evaluated in early phase trials as a monotherapy for HRR-deficient mCRPC. Among them, olaparib and rucaparib have breakthrough designations for BRCA1/2-mutated mCRPC. Phase II studies also reported clinical activity of the PARPi and abiraterone combination and the PARPi checkpoint inhibitor combination in HRR-intact mCRPC. Ongoing phase III trials are testing these combinations as frontline or later line treatments for mCRPC. This review summarizes the critical clinical data as well as ongoing clinical trials for developing PARPi in treating mCRPC.

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