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Add Chemo or Abiraterone to hormone therapy for metastatic men when hormone therapy is still working


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Jim Marshall (not a doctor) said ...

Dr Alicia Morgans, a medical oncologist, is AssistantProfessor of Medicine at the Vanderbilt University in Nashville, Tennessee, USA. Dr Morgans is an expert in the design and reporting of clinical trials. She travels the world talking to conferences of medical oncologists about this. 


When Dr Morgans was in Australia recently to address such a conference, I had the opportunity to interview her for a series of YouTube videos on "Bones and Advanced Prostate Cancer".

If you missed those videos, there is a link at the bottom of this post.


In the recent Phone-in Meeting we had with medical oncologist Dr Mark Moyad, Dr Moyad reported on the important research that has been published in 2017. Along with a host of useful information, Dr Moyad mentioned clinical trials LATITUDE,STAMPEDE and CHAARTED. These trials all showed that certain groups of men with metastatic prostate cancer got longer survival if they added either Docetaxel chemotherapy or Abiraterone to the standard treatment (hormone therapy, ADT).

If you missed that meeting, there is a link at the bottom of this post.


No research shows which is better to add to hormone therapy first - chemo or abiraterone. So which treatment do doctors offer first?


Today Dr Morgans addressed her fellow medical oncologists and urologists in UroToday about what treatment she will offer men who have metastatic prostate cancer that is still hormone sensitive - men who are just starting hormone therapy and men whose hormone therapy is keeping their PSA low.(Doctor's shorthand for this men is mHSPC - metastatic hormone sensitive prostate cancer.) 

My translation of Dr Morgan's words:

She offers chemo first to men who are fit enough (high performance status), followed by abiraterone.

... end Jim


Dr Morgans said

... should we consider giving both treatments to all patients with a performance status suitable for chemotherapy, or should we avoid the side effects of chemotherapy in patients who will not benefit and simply give everyone abiraterone only? Since we cannot identify which patients fall into which category, this could be a complicated question to answer. From my perspective, the answer seems somewhat straightforward.  Until we demonstrate that one group of patients benefits from one approach but not the other, I will offer all interested patients with an acceptable performance status treatment with docetaxel, followed by treatment with abiraterone.  Part of this stems from my unwillingness to withhold a potentially beneficial treatment from anyone based on my assumptions that a patient would not be interested in chemotherapy ...


Click this sentence to read the whole article by Dr Morgans.

(This article is on UroToday. It is only available to members, so you will have to join up to see it. Joining is free.)


Click this sentence to see a half hour video where Dr Morgans discusses this with Dr Charles Ryan for the benefit of fellow medical oncologists.

(This video is on UroToday. It is only available to members, so you will have to join up to see it. Joining is free.)


Click this sentence to see our series of YouTube videos with Dr Alicia Morgans on bones and advanced prostate cancer.


Click this sentence to see our YouTube video of our recent phone-in meeting with Dr Mark Moyad: Prostate Cancer Research Report 2017.

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As Jim knows, we posed this very question to Dr. Moyad 10 days ago .... Jim - I would be tempted to send Dr. Moyad Dr. Morgans' article and the discussion between her and Chuck Ryan, since Dr. M recognized the importance of the question  but didn't have a great answer yet.

I recently recommended Dr. Morgans to two gents seeking GU med oncs - one in Chicago where she has just moved to Northwestern, and one in Tennessee where she has just left (Vanderbilt). Our Chicago guy was able to make contact, in fact received a charming e-mail back, and has an upcoming appointment to see her.

As always Jim, thanks so much for the UroToday links - I have already sent them on to several folks.

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