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Prostate Cancer Active Surveillance Support Group
This is an online/telephone support group for men with low grade prostate cancer who are treating their cancer with or want to learn more about active surveillance (AS). We meet on the 2nd Wednesday of each month.
If you are interested in learning more about the group or wish to join us send an email to:
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Free Patient/Caregiver Conference
Join Drs. Dan Petrylak, Ash Tewari, Scott Tagawa, Phillips Cheetham and ten other prostate cancer experts as they spend an entire day talking with you about prostate cancer. Listen to their presentations and have plenty of time to interact with them, asking your questions and learning about p.c. Topics include genetics, active surveillance, advanced treatments, clinical trials, news and hot topics, long term care issues, nutrition and on and on.
The conference is in Jersey City, NJ - one stop from Manhattan on the PATH Train. Easy public transportation as well as car access and parking.
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Docetaxel Extends Enzalutamide Effectiveness
In a recent randomized clinical trial, the PRESIDE Trial, Enzalutamide (Xtandi) showed that chemotherapy with docetaxel (Docetaxel) not only improved survival in men with metastatic castration-resistant prostate cancer (mCRPC), it sometimes reversed enzalutamide resistance.
PRESIDE was a randomized clinical trial that treated 687 men with mCRPC across 123 European sites. All the men were administered enzalutamide in addition to hormone therapy (ADT). After 13 weeks, 271 men had an increase in their PSA and/or an increase in tumor size based on scans. At this point, they were randomly assigned to have either:
A. Triplet therapy, combining enzalutamide, docetaxel, and ADT, or
B. Docetaxel, ADT, and placebo.
The men receiving the triplet therapy outperformed those receiving only docetaxel plus ADT in progression-free survival. This finding indicates that the enzalutamide was still efficacious for those who were also receiving ADT and docetaxel. The difference was modest but statistically significant.
Both experimental groups had similar treatment-related side effects, primarily caused by the chemotherapy, docetaxel. However, the triplet group experienced more significant incidents (49% vs 39%).
A similar randomized trial (ABIDO) used abiraterone along with ADT and chemotherapy as an alternate triplet therapy. Data showed that this triplet had considerably worse toxicity, particularly causing neutropenia, the presence of abnormally few white blood cells in the blood leading to an increased susceptibility to infection.
.
PRESIDE is the first evidence that docetaxel might reduce enzalutamide resistance when given together. It also suggests that triplet therapy may be helpful in men who have already developed castration resistance.
#Triplet Therapy#docetaxel#taxotere#Enzalutamide#Enzalutamide Failure#triple therapy#PRESIDE Trial#ABIDO Trial
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CAUTION: WHAT YOU DISCLOSE ONLINE ABOUT YOUR HEALTH IS NOT PROTECTED BY HIPA REGULATIONS.
It is common practice for patients, myself included, to disclose a lot of personal information about our medical situation to digital medical companies on social media platforms like Facebook and Twitter. We disclose information about our treatments, scans, side effects, etc. When we do this, we need to know that this information is tracked and used to generate ads that specifically address our health interests.
We share our health data when they sign up for and use medical apps and websites or share details about our health issues with others on social media. Digital medicine companies and social media platforms track this information and use it to develop targeted ads aimed at both other individuals with specific medical problems and us. They also use this information to generate leads for future marketing purposes.
HIPAA rules bar "covered entities" such as medical practices and hospitals from disclosing our protected health information without first receiving our consent. But for data generated outside the covered entities, there aren't any HIPA protections. Without HIPA protection, we are primarily on our own concerning understanding how companies utilize our personal and health data when we are on social media.
The Light Collective, an advocacy group, based in Eugene, Oregon, along with Andrea Downing and Eric Perakslis, Ph.D., Chief Science and Digital Officer at the Duke Clinical Research Institute in Durham, North Carolina, explored this issue in a study of health-advertising tactics of 5 digital medicine companies, with a focus on five clinical services. They recruited ten patient advocates in the hereditary cancer community and asked them to share data on how their online activities were tracked.
The participants downloaded and shared their JavaScript Object Notation (JSON) files, which reveal how data are transferred between web servers and web apps. To target advertising, the investigators used these files to determine how information flows from health-related websites and apps to Facebook.
The researchers then reviewed the company's websites for third-party ad trackers. They looked at the use of the trackers to determine if they were being used in compliance with the company's privacy policies.
They also looked at Facebook's ad library for each research participant to evaluate whether the health data being mined influenced the types of ads targeted to the participants.
According to Downing and Perakslis, "We demonstrated that personal data and personal health data can be easily obtained without the aid of highly sophisticated cyberattack techniques but with rather commonplace third-party advertising tools," the authors wrote in a paper published in the journal Patterns.
There is nothing wrong with disclosing personal information on social media as long as you always remember that once it is out there, it is available to anyone, including potential advertisers who will use it to target you.
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CAUTION: WHAT YOU DISCLOSE ONLINE ABOUT YOUR HEALTH IS NOT PROTECTED BY HIPA REGULATIONS.
It is common practice for patients, myself included, to disclose a lot of personal information about our medical situation to digital medical companies on social media platforms like Facebook and Twitter. We disclose information about our treatments, scans, side effects, etc. When we do this, we need to know that this information is tracked and used to generate ads that specifically address our health interests.
We share our health data when they sign up for and use medical apps and websites or share details about our health issues with others on social media. Digital medicine companies and social media platforms track this information and use it to develop targeted ads aimed at both other individuals with specific medical problems and us. They also use this information to generate leads for future marketing purposes.
HIPAA rules bar "covered entities" such as medical practices and hospitals from disclosing our protected health information without first receiving our consent. But for data generated outside the covered entities, there aren't any HIPA protections. Without HIPA protection, we are primarily on our own concerning understanding how companies utilize our personal and health data when we are on social media.
The Light Collective, an advocacy group, based in Eugene, Oregon, along with Andrea Downing and Eric Perakslis, Ph.D., Chief Science and Digital Officer at the Duke Clinical Research Institute in Durham, North Carolina, explored this issue in a study of health-advertising tactics of 5 digital medicine companies, with a focus on five clinical services. They recruited ten patient advocates in the hereditary cancer community and asked them to share data on how their online activities were tracked.
The participants downloaded and shared their JavaScript Object Notation (JSON) files, which reveal how data are transferred between web servers and web apps. To target advertising, the investigators used these files to determine how information flows from health-related websites and apps to Facebook.
The researchers then reviewed the company's websites for third-party ad trackers. They looked at the use of the trackers to determine if they were being used in compliance with the company's privacy policies.
They also looked at Facebook's ad library for each research participant to evaluate whether the health data being mined influenced the types of ads targeted to the participants.
According to Downing and Perakslis, "We demonstrated that personal data and personal health data can be easily obtained without the aid of highly sophisticated cyberattack techniques but with rather commonplace third-party advertising tools," the authors wrote in a paper published in the journal Patterns.
There is nothing wrong with disclosing personal information on social media as long as you always remember that once it is out there, it is available to anyone, including potential advertisers who will use it to target you.
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Analysis Finds Timing of ADT with Radiation Impacts Outcomes in Localized Prostate Cancer
Generally, it is accepted that men with prostate cancer who elect to have radiation as their primary treatment benefit from also having short-term androgen deprivation therapy (ADT).
Historically, ADT is used before beginning radiation.
In a recent extensive analysis of over 7,400 men with data from 12 international randomized trials, it has been shown that it is optimal for men to begin ADT when starting radiation. This way, most of the period of low testosterone levels is "backloaded" after radiation has been completed.
The analysis included 6,325 men who had received ADT before and during (neoadjuvant/concurrent) radiation therapy and 1,084 men who received ADT during and after (concurrent/adjuvant) undergoing RT. The median follow-up period was 10.2 years.
For men receiving prostate-only radiation, ADT occurring during and after radiation was associated with improved metastasis-free survival compared with neoadjuvant/concurrent ADT.
The exception to this finding was with men who had whole-pelvis radiation instead of radiation targeted solely to the prostate gland. Men receiving whole-pelvis radiation did not have a different result based on the sequencing of the ADT, except they did have more distant metastasis occurrence among those who had concurrent/adjuvant ADT. However, that finding should be interpreted with caution due to details on how the individual trials were structured.
CONCLUSION
The authors concluded that ADT sequencing significantly impacted clinical outcomes with a strong correlation to RT field size. They believe concurrent, and adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with prostate radiation.
This study appears in the Journal of Clinical Oncology
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Bipolar Androgen Therapy (BAT): A Patient's Guide
I am not in the habit of publishing entire abstracts, but given the considerable interest in the therapy termed "BAT" or bipolar androgen therapy, I thought that this specific abstract, along with the link to the complete guide, would answer many questions that we hear regularly.
This guide is written in plain language and is specifically designed for patients and their families. It is written by Dr. Samuel Deneade, M.D., the father of BAT.
Abstract
Bipolar androgen therapy (BAT) is a new treatment concept for men whose prostate cancer has become resistant to standard hormone‐blocking therapy. Over the past decade, we have performed a series of clinical studies testing BAT in asymptomatic men with castration‐resistant prostate cancer. The key findings from these clinical studies are that BAT (a) can be safely administered to asymptomatic patients with metastatic castrate‐resistant prostate cancer; (b) does not produce symptomatic disease progression; (c) produces sustained prostate‐specific antigen and objective responses in 30%–40% of patients; and (d) can resensitize and prolong response to subsequent antiandrogen therapy. The concept of BAT has generated significant interest from men with prostate cancer, their families, and their physicians. Here we provide a "Patient's Guide" that answers questions about BAT in a form that is accessible to patients, their families, and physicians. Our goal is to provide information to help patients make the most informed decisions they can regarding their prostate cancer treatment.
The complete guide should be your stepping-off point if you are interested in BAT.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9313844/
Prostate. 2022 May 15; 82(7): 753–762.
Published online 2022 Mar 31. doi: 10.1002/pros.24328
PMCID: PMC9313844
PMID: 35357024
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Obtaining Mental Health Services When You Have Cancer
Yesterday was World Mental Health Day. Historically, World Mental Health Day is simply recognized, maybe posted about, and passed without significant changes. Years of listening to and interacting with cancer patients have taught us at Cancer ABCs that the cancer experience permeates all parts of life, medical and other. A cancer diagnosis is a life-altering diagnosis; it cannot just be marked, moved through, or passed through. Cancer is a life-changing experience for individuals, their families, and the community.
At Cancer ABCs, we understand that cancer diagnosis and treatment are emotionally draining for all. Depression and anxiety are more prevalent in the cancer community, which often impacts treatment outcomes. Depression, anxiety, and fear can make it difficult for patients to participate in therapy, adhere to treatment regimens, and even participate in life. Patients facing mental health issues may have difficulty maintaining a healthy lifestyle, impacting how well cancer therapies work.
Often, the availability of mental health support resources is not known by patients and their families. Too many doctors who treat cancer patients regularly neglect to ask their patients about their mental health. Frequently, even if they know that a patient is struggling with any mental health concern, they fail to connect the patient to available resources! In reality, many resources are available to help patients, caregivers, and their loved ones deal with their mental health issues. So if you are experiencing depression, anger, anxiety, or feel things aren’t right, ask your doctor to connect you to help.
Most hospitals have social work departments that are there to assist you. If your doctor cannot help, call the American Psychosocial Oncology Society (APOS), which offers a toll-free national Helpline (1-866-APOS-4-HELP) as a resource to help people with cancer and their caregivers find counseling services in their own communities. You can also send an e-mail to [email protected].
The following information will be requested when you call or write:
Caller’s name (spelling of the last name)
Contact phone number(s), including area code
Patient’s city/town and state of residence
Zip code of the location where you are searching for a referral
Calls are accepted 24 hours a day through a voicemail system and then handled by trained staff members who have access to a national directory of community mental health resources. Helpline inquiries are normally returned within 24 to 48 hours.
For additional information, visit http://www.apos-society.org/.
There is no reason that anyone with cancer should suffer mental health issues alone.
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Obtaining Mental Health Services When You Have Cancer
Yesterday was World Mental Health Day. Historically, World Mental Health Day is simply recognized, maybe posted about, and then passed without any significant changes. Years of listening to and interacting with cancer patients have taught us at Cancer ABCs that the cancer experience permeates all parts of life, medical and other. A cancer diagnosis is a life-altering diagnosis; it cannot just be marked, moved through, or passed through. Cancer is a life-changing experience for individuals, their families, and the community.
At Cancer ABCs, we understand that cancer diagnosis and treatment are emotionally draining for all. Depression and anxiety are more prevalent in the cancer community, which often impacts treatment outcomes. Depression, anxiety, and fear can make it difficult for patients to participate in therapy, adhere to treatment regimens, and even participate in life. Patients facing mental health issues may have difficulty maintaining a healthy lifestyle, impacting how well cancer therapies work.
Often, the availability of mental health support resources is not known by patients and their families. Too many doctors who treat cancer patients regularly neglect to ask their patients about their mental health. Frequently, even if they know that a patient is struggling with any mental health concern, they fail to connect the patient to available resources! In reality, many resources are available to help patients, caregivers, and their loved ones deal with their mental health issues. So if you are experiencing depression, anger, anxiety, or feel things aren’t right, ask your doctor to connect you to help.
Most hospitals have social work departments that are there to assist you. If your doctor cannot help, call the American Psychosocial Oncology Society (APOS), which offers a toll-free national Helpline (1-866-APOS-4-HELP) as a resource to help people with cancer and their caregivers find counseling services in their own communities. You can also send an e-mail to [email protected].
The following information will be requested when you call or write:
Caller’s name (spelling of the last name)
Contact phone number(s), including area code
Patient’s city/town and state of residence
Zip code of the location where you are searching for a referral
Calls are accepted 24 hours a day through a voicemail system and then handled by trained staff members who have access to a national directory of community mental health resources. Helpline inquiries are normally returned within 24 to 48 hours.
For additional information, visit http://www.apos-society.org/.
There is no reason that anyone with cancer should suffer mental health issues alone.
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Differential Treatment Response for Hormone Sensitive Men with Nodal Metastases – Nodal Burden as a Prognostic Biomarker
Men with prostate cancer with both nodal and bone metastases due worse with ADT plus docetaxel chemotherapy than men with only bone metastases. In addition, increased nodal metastases burden is a negative prognostic biomarker.
A presentation by Dr. Áine Haran at ESMO 2022 discussed an ancillary study from the phase III STAMPEDE trial of docetaxel (chemotherapy) and abiraterone acetate (Zytiga) and prednisolone, specifically looking at the differential treatment responses in men who are hormone sensitive and have metastases in their lymph nodes (soft tissue) (mHSPC). The presentation evaluated the nodal burden (how many positive nodes existed) as a prognostic biomarker.
We know that we need to have a better selection process of men for the addition of docetaxel in mHSPC. Previous work has suggested that increased disease burden correlates with worse outcomes, but the existence of nodal metastases has not been considered in metastatic volume definitions in mHSPC.
The study concluded that men with bone-only metastases treated with ADT + docetaxel had a similar survival benefit (HR 0.62, 95% CI 0.46-0.84). However, the survival benefit was reduced for men with both nodal and bone metastases when given ADT + docetaxel (HR 0.89, 95% CI 0.74-1.07). Higher nodal burden had significantly worse outcomes in both control arms and the intervention arm of ADT +/- abiraterone acetate and prednisolone.
Dr. Haran concluded the presentation by discussing differential treatment response with nodal metastases in mHSPC and evaluation of nodal burden as a prognostic biomarker with the following take-home messages:
The increased nodal burden is a negative prognostic biomarker and should be considered in prospective risk/volume definitions to aid risk stratification in selected patients.
This study also demonstrates for the first time a potential differential response between mHSPC patients with nodal +/-bone metastases versus bone-only metastases for ADT + docetaxel but not for ADT + abiraterone acetate and prednisolone.
Áine M. Haran, Genito-urinary Cancer Research Group, The University of Manchester, Manchester, UK
2022 European Society of Medical Oncology (ESMO) Annual Hybrid Meeting, Paris, FR, Fri, Sept 9 – Tues, Sept 13, 2022.
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Medicare Open Enrollment Is Approaching
Fall Open Enrollment for Medicare every year begins on October 15 and finishes on December 7. (This is also known as Medicare's Open Enrollment Period or Annual Election Period.) You can make changes to your health insurance coverage during this time, such as adding, deleting, or modifying your Medicare Advantage and Part D coverage for the coming year. Even if you are satisfied with your existing health and medication coverage, now is the time to assess it. Compare it to alternative options, and ensure that your current plan will satisfy your next year's needs.
During Fall Open Enrollment, you can make as many changes to your Medicare coverage as you need; these changes can include:
Participating in a new Medicare Advantage Plan
Participating in a new Part D prescription medication plan
Making the switch from Original Medicare to a Medicare Advantage Plan
Making the switch from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan)
When you make these decisions, you should consider the following:
Your ability to see the health care providers you desire
Your ability to use preferred pharmacies
Your ability to obtain necessary benefits and services
The total cost of insurance premiums, deductibles, and copayments.
If you have Original Medicare, go to www.medicare.gov or read the 2023 Medicare & You guide to learn about the future year's benefits. You should review any increases in Original Medicare premiums, deductibles, and coinsurance rates.
If you have a Medicare Advantage Plan or a separate Part D plan, read the Annual Notice of Change (ANOC) and Evidence of Coverage for your plan (EOC). If you haven't received these notices before the end of September, contact your plan and ask for them. Examine these alerts for any updates to:
The costs of the plan
The benefits and coverage rules of the plan
The formulary of the plan (list of drugs your plan covers)
Check to see if your medications will still be covered next year and if your providers and pharmacies are still in the plan's network. If you are dissatisfied with any of your plan's changes, you can switch to a different plan.
If you need help weighing your alternatives, call your state's Health Insurance Assistance Program (SHIP) for unbiased advice.
Even if you are satisfied with your current Medicare coverage, you should look into other Medicare health and drug plans available in your area. Even if you do not intend to change your Medicare Advantage or Part D plan, you should investigate whether another plan in your area provides better health and drug coverage at a lower cost. According to research, persons with Medicare prescription medication coverage can save money by shopping around each year; there may be another Part D plan in your area that covers the drugs you take with fewer restrictions and lower pricing. You can compare your options using Medicare's Plan Finder tool and contact your SHIP for assistance.
Following the recommendations above can ensure that your health insurance will match your needs in 2023.
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Metformin Did Not Prevent Anthropometric and Metabolic Complications of ADT in Men With Prostate Cancer Receiving Radical Radiotherapy
TAKE-HOME MESSAGE
This phase II randomized controlled trial evaluated the preventive impact of the addition of Metformin versus placebo to androgen deprivation therapy (ADT) on ADT-induced metabolic and anthropometric (body/fat ratios and size) complications in 79 men with locally advanced prostate cancer who received radical radiotherapy. At 1 year, both groups had similar weight, waist circumference, HbA1c, fasting lipid profile, the prevalence of metabolic syndrome, and biochemical response.
The conclusion is that Metformin did not have a preventive impact on ADT's anthropometric and metabolic complications in men with locally advanced prostate cancer receiving radiotherapy.
BACKGROUND
Prostate cancer patients undergoing radical radiotherapy (RT) plus androgen deprivation therapy (ADT) experience many negative metabolic and anthropometric changes associated with increased morbidity and mortality. This study assessed the impact of Metformin versus placebo to blunt the adverse effects of ADT on body weight, waist circumference, and other metabolic parameters.
METHODS AND MATERIALS
This study was a phase 2, multicenter, randomized controlled trial that evaluated men with locally advanced prostate cancer receiving radical RT and ADT (18 to 36 months) in a 1:1 ratio to receive Metformin 500mg by mouth three times a day (for 30 to 36 months) versus a placebo.
RESULTS
From December 2015 to October 2019, 83 men were randomized with a median follow-up of 23 months. The cohort's baseline mean body mass index (BMI) was 30.2 (range 22.2-52.5). Change in mean weight relative to baseline was lower amongst men who received Metformin compared to placebo at 5 months (-1.80 kg, p=0.038). Still, it was not significant with longer follow-up (1 year: +0.16 kg, p=0.874). Although participants on ADT had increases in waist circumference in both study arms, Metformin did not significantly reduce these changes (1 year: +2.79 cm (placebo) vs. +1.46 cm (Metformin), p=0.336). LDL cholesterol was lower in the metformin arm (-0.32 mmol/L) when compared to the placebo arm (-0.03 mmol/L) at 5 months (p=0.022). Still, these differences were insignificant with longer follow-ups (1 year: -0.17 mmol/L vs. -0.19 mmol/L, p=0.896). The study arm showed no differences in HbA1C, triglyceride, HDL, and total cholesterol.
CONCLUSIONS
Men receiving radical RT and ADT gained weight. They had increases in waist circumference over time, which Metformin did not significantly mitigate. Although this study did not observe any preventative impact of Metformin on the anthropometric and metabolic complications of ADT, Metformin continues to be studied in phase 3 RCTs in this patient population to assess its potential anti-neoplastic effects.
International Journal of Radiation Oncology, Biology, Physics
Metformin for Prevention of Anthropometric & Metabolic Complications of Androgen Deprivation Therapy in Prostate Cancer Patients Receiving Radical Radiotherapy: A Phase II Randomized Controlled Trial
Int. J. Radiat. Oncol. Biol. Phys 2022 Jul 27;[EPub Ahead of Print], N Usmani, S Ghosh, KP Sanghera, AD Ong, R Koul, A Dubey, S Ahmed, H Quon, D Yee, M Parliament, G Sivananthan, W Hunter, B Danielson, L Rowe, M McDonald, JO Kim
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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Prostate Cancer Active Surveillance Support Group
This is an online/telephone support group for men with low grade prostate cancer who are treating their cancer with or want to learn more about active surveillance (AS). We meet on the 2nd Wednesday of each month.
If you are interested in learning more about the group or wish to join us send an email to:
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Free Patient Conference in the Villages, Fla with Dr, William Oh, Dr. Judd Moul and 10 other doctors, patient presenters and advocates
Cancer ABCs free prostate cancer patient conference will assist you to become a CANCER THRIVER
JOIN US FOR THE CANCER ABCS FREE PATIENT/CAREGIVER CONFERENCE ON NOVEMBER 5, 2022 AT THE BROWNWOOD HOTEL AND SPA IN THE VILLAGES, FLORIDA
A FREE CONFERENCE WITH FREE LUNCH AND DISCOUNTED HOTEL ROOMS
FOR PEOPLE WITH PROSTATE CANCER AND THEIR CAREGIVERS/LOVED ONES.
Go to the Conference Website to Register
ABOUT THIS EVENT
NATIONAL EXPERTS - LOCAL EXPERTS
PHYSICIANS - NURSES - COUNSELORS - ADVOCATES - PATIENTS
DON'T MISS THIS CHANCE TO INTERACT WITH, AND LEARN FROM SOME OF THE BEST EXPERTS. SESSIONS WILL INCLUDE OVER A DOZEN DIFFERENT SUBJECTS, MODERATED Q&A, AND HANDOUTS. THERE WILL BE SOMETHING FOR EVERYONE - FROM THE NEWLY DIAGNOSED, TO PEOPLE WITH ADVANCED PC, CAREGIVERS, AND LOVED ONES.
For More Information Go To Our Landing Page
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Advanced, Metastatic and Recurrent Prostate Cancer Support Group
This group meets with Us TOO New York every first Thursday of the month at 6 p.m. It is a drop-in group that does not require reservations; just join us. Come once or come to all of our meetings.
This group is only for men who have been diagnosed with recurrent prostate cancer, locally advanced and metastatic prostate cancer.
This meeting is remote. It is entirely on Zoom. You can join us on your computer, tablet or on your phone.
Join Zoom Meeting
https://us02web.zoom.us/j/84748379973
Or: www.zoom.us
and click on Join A Meeting
Meeting ID: 847 4837 9973
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Pluvicto is Approved By Health Canada
The good news for our Canadian patients is that Health Canada has approved Pluvicto (lutetium (177Lu) vipivotide tetraxetan injection) for the treatment of men with prostate-specific membrane antigen (PSMA) positive metastatic castration-resistant prostate cancer (mCRPC) who have received at least one androgen receptor pathway inhibitor (ARPI) and taxane-based chemotherapy.
Pluvicto is a precision cancer treatment that combines a targeting compound (ligand) with a therapeutic radioisotope (a radioactive particle). This means that the radioisotope treatment (a radioactive particle) is delivered directly to the cancer cells.
Now, let's unpack who could qualify to receive this treatment.
1- This particular approval only affects men living and being treated in Canada; other countries have already approved Pluvicto.
2- Men must have confirmed metastatic castrate-resistant prostate cancer (mCRPC). This means that the prostate cancer must have left the prostate gland and spread to a different site other than the prostate gland. In addition, the prostate cancer must have stopped responding to first-line hormone therapy treatments (ADT) like Lupron, Eligard, Trelstar, or Zoladex.
Treatment nonresponse is measured by a rising prostate-specific antigen (PSA blood test) despite confirming that these medications have dropped the testosterone blood levels to a castrate level.
3- Men must also have had and failed (as indicated by a rising PSA blood test) at least one of the second-line or androgen receptor pathway inhibitor (ARPI) medications like Erleada (apalutamide), Nubequa (darolutamide), Xtandi (enzalutamide) or Zytiga (abiraterone).
4- Men must also have chemotherapy with a taxane-based drug like Taxotere (docetaxel) or Jevtana (cabazitaxel).
5- The prostate cancer must be confirmed to be PSMA positive, or the tumor must express prostate-specific membrane antigen (PSMA) on the cancer cell's surface. Only about 80% of prostate cancer is PSMA positive. A positive PSMA scan confirms the presence of PSMA.
To qualify, men must meet all of the above criteria.
Pluvicto is administered into the bloodstream by a specially trained doctor who handles radioactive drugs. Once the drug is administered, the Pluvicto targets (finds) the PSMA being expressed on the prostate cancer cell surfaces, directly delivering the treatment radioisotope to the cancer cell. The radioisotope disrupts the cancer cell's ability to duplicate itself and triggers cell death.
The Health Canada approval of Pluvicto is based on the pivotal Phase III VISION trial results. The trial randomized patients with PSMA-positive mCRPC who received 177Lu-PSMA-617 in addition to best supportive/best standard of care (BSC/BSoC) versus patients treated with BSC/BSoC alone.
The full product monograph for Pluvicto can be found at https://www.adacap.com/our-products/.
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Which is Better, 177Lu-PSMA-617 (Pluvicto) or Xofigo
Several men have asked us if they are better off having 177Lu-PSMA-617 (Pluvicto) or Xofigo, a radiopharmaceutical drug that treats bone metastases. There is no simple answer, and the answer is not the same for each of us. Making a sound decision can be helped by understanding the mode of action and the limits of each treatment.
Like some other radiopharmaceuticals, both of these treatments have two components, a drug that delivers, or targets, the therapy to the cancer cells and a radioactive particle that treats or destroys the cancer cells after they have been delivered to the Mets.
In the case of 177Lu-PSMA-617, the delivery vehicle (ligand) is PSMA-617 (aka, vipivotide tetraxetan), a drug that latches onto a protein called PSMA that is often found at high levels on the surface of prostate cancer cells. The protein, PSMA, is present in bone and soft tissue prostate cancer Mets, but only in around 80 to 90 percent of men.
The radioactive component or the actual treatment drug is lutetium-177.
For a more in-depth explanation see:
cen.acs.org/pharmaceuticals...
The delivery vehicle for Xofigo mimics calcium, and calcium goes (targets) bones. So, Xofigo specifically goes to the bones, and the attached radiation treatment treats the Mets in the bones; Xofigo will not treat soft tissue Mets.
One treatment is not better than the other; they are different. Pluvicto and Xofigo have different targeting abilities. Pluvicto targets PSMA, but not all men express the protein PSMA. If you do express PSMA, verified by a positive PSMA scan, then Pluvicto can treat both bone and soft tissue Mets. If you do not express PSMA, Pluvicto will not treat your Mets. For men with only bone, Mets Xofigo will target and treat the Mets.
After this discussion, we do need to add some additional complications.
• You cannot get Pluvicto soon after Xofigo, but you can get Xofigo after Pluvicto. I am unaware of a good reason for this - it was just how Pluvicto was tested and approved.
• Xofigo combines well with some other medicines:
prostate cancer.news/2021/02...
• PSMA expression can be heterogeneous, so even one tumor part could express PSMA (and be treated), and part might not express PSMA and not be treated.
In summary, Xofigo only attacks bone metastases but attacks all of the bone Mets you might have. Pluvicto only attacks cancer cells that express PSMA, and not all men and not all tumors express PSMA.
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