Common Prostate Cancer Treatments Suppress Immune Response and May Promote Relapse

Excerpt:

“Prostate cancer patients and their doctors may want to think twice about the best timing for chemotherapy or radiation therapy in conjunction with a common nonsurgical treatment, based on international research findings led by UT Southwestern Medical Center investigators.

“Researchers using mouse models found that many medical androgen deprivation therapies (ADTs) – the most commonly used nonsurgical treatments for prostate cancer – may suppress patients’ adaptive immune responses, preventing immunotherapies from working if both treatments are used but not sequenced properly. ADTs are anti-hormone therapies that decrease the body’s levels of androgens, the type of hormone that is required for prostate cancer to survive and grow.

“The study findings were published this week in Science Translational Medicine.”

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Shorter, Intensive Radiation Can Be Recommended in Early Prostate Cancer

Excerpt:

“Giving early-stage prostate cancer patients a slightly higher daily dose of radiation can cut more than two weeks from the current treatment regimen without compromising cancer control, according to a national study led by a Duke Cancer Institute researcher.

“Publishing April 4 in the Journal of Clinical Oncology, the research team compared the shortened  therapy schedule of about 5.5 weeks to the standard 8-week regimen to determine if rates of cure were similar. Both treatment schedules were similar in terms of controlling cancer, but doctors reported slightly more mild side effects in  getting the shorter radiation schedule.

” ‘This study has implications for public policy,’ said the study’s principal investigator, W. Robert Lee, M.D., a professor in the Department of Radiation Oncology at Duke. ‘Because the shorter regimen has advantages such as greater patient convenience and lower costs, it’s important to establishing whether we can cure as many patients with the shorter regimen. Our study provides that information for the first time.’ ”

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Cancer Immunotherapies and Radiation Form Powerful Combination Therapy, Researchers Say

Excerpt:

“Cancer immunotherapy relies on the stimulation of the patient’s own immune system for an effective and lasting anti-tumor response, targeting and eliminating cancer cells. Both the research and clinical communities believe that combining cancer immunotherapy with more traditional anti-cancer treatments, such as radiation, is one of the more exciting new research areas in cancer treatment.

Charlie Garnett Benson, who is working on tumor immunity at Georgia State University, recently wrote about cancer immunity and combination therapy, the cutting-edge research areas listed in the new National Cancer Moonshot initiative highlighted by President Barack Obama in his final State of the Union address.

“Current cancer therapies include some combination of radiation, surgery, and chemotherapy for most patients. Ionizing radiation, one of the oldest and more commonly used types of cancer treatment, consists of high energy waves that damage the DNA of cancer cells leading to cell death, called cell suicide or apoptosis. But radiation can also affect the healthy cells surrounding tumor tissues, so there is a limit of how high a dose a patient can receive without leading to healthy cellular damage and death.”

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"Radiation Combined With Immune-Stimulating Drugs Could Pack a Powerful Punch Against Cancer Cells"

Excerpt:

“In his final State of the Union address, President Obama tasked Vice President Joe Biden with leading a new National Cancer Moonshot initiative. The hope is that this will put America on course to be ‘the country that cures cancer once and for all.’ Listed among the cutting-edge research areas of the initiative is a class of treatments called cancer immunotherapy and combination therapy.

“Cancer immunotherapies are treatments that stimulate the immune system to target and attack cancer. Researchers now believe that combining immunotherapy with traditional therapies could open up new possibilities for cancer treatment.

“For instance, radiation is one of the oldest and most commonly used forms of cancer treatment out there. But there are limits to how much radiation a person can receive, and it can’t kill every cancer cell. However, in combination therapy, radiation could be paired with immunotherapy to pack a one-two punch against .”

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Video: Dr. Matthew Cooperberg on Surgery for Aggressive Prostate Cancer

“Matthew Cooperberg, MD, genitourinary cancer specialist, University of California San Francisco, discusses the rise in aggressive management of men with high-risk prostate cancer. Cooperberg says the proportion of men who are receiving hormonal therapy alone had been rising consistently over the course of a 15 year period, up until 2010, to about 50%. Since then, Cooperberg says that number has dropped to about half of what it was, or 25%, which is attributed to more aggressive treatment.

“Cooperberg says local therapy for men with high-risk prostate cancer was normally radiotherapy, with surgery not being nearly as common. He adds that a growing body of evidence dictates that surgery in prostate cancer may be a more effective local therapy than radiation alone. According to the body of evidence, cancer-related survival and overall survival were normally boosted when surgery was involved for these patients.”

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Higher Volume Radiation Facilities Associated With Better Survival Rates for Men with High Risk Prostate Cancer

Excerpt:

“In a new study led by researchers at Brigham and Women’s Hospital, investigators looked at men with aggressive prostate cancer who were treated with radiation as well as the case volume of the facility at which they were treated.  They found that receiving radiation at a facility that treats a high volume of prostate cancer patients with radiation was associated with improved overall survival.

“These findings are published online and appear in the March 15, 2016 issue of the International Journal of Radiation Oncology, Biology, and Physics...”

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Androgen Suppression Plus RT Improves DFS in Prostate Ca

“Adding 6 months of androgen suppression (AS) to radiation therapy improved biochemical disease-free survival in high-risk localized prostate cancer patients – even at radiation doses of 78 Gy – and it did so with acceptable adverse effects, according to a randomized European Organisation for Research and Treatment of Cancer trial reported in the Journal of Clinical Oncology.

“At 7.2 years’ median follow-up, the study found that combination therapy led to a 5-year biochemical disease-free survival of 82.6% (95% CI 78.4-86.1) versus 69.8% for radiation alone (95% CI 64.9-74.2) – translating to a hazard ratio of 0.52 (95% CI 0.41-0.66, P=0.001, 319 events). Adjuvant AS also improved clinical progression-free survival, for an HR of 0.63 (95% CI 0.48-0.84, P=0.001, 205 events).

“No statistically significant interaction between treatment effect and radiation dose emerged: heterogeneity P=0.79 and P=0.66, for biochemical disease-free survival and progression-free survival, respectively, according to Michel Bolla, MD, of Grenoble University Hospital in France, and colleagues.”


Surgery Improves Survival Rates for Men With Prostate Cancer If Radiation Treatments Fail

“Approximately 14 percent of men will be diagnosed with prostate cancer at some point in their lifetimes, according to the National Institutes of Health. Radiation therapy traditionally has been a primary treatment for the cancer, but one-fourth of men have a recurrence of prostate cancer within five years after the therapy. Now, a University of Missouri School of Medicine researcher has found that a complex procedure to remove the prostate achieves excellent long-term survival for men after radiation therapy has failed.

” ‘Prostate cancer, unfortunately, is a common cancer, and more than 27,000 men are estimated to have died from the disease in 2015,’ said Naveen Pokala, M.D., an assistant professor in the Division of Urology at the MU School of Medicine and lead author of the study. ‘By studying a national database of prostate cancer cases, we found that a procedure known as salvage radical prostatectomy can greatly increase a man’s chance of survival when traditional radiation therapy has failed to eradicate the cancer.’ ”


Hypofractionation Is Ready for Prime Time in Prostate Cancer, but Will It Be Adopted?

“Separate phase III trials presented at the 2016 Genitourinary Cancers Symposium demonstrated that modest hypofractionated radiotherapy is noninferior to conventional radiotherapy for men with intermediate- and low-risk prostate cancer and should be considered a new standard of care.1,2 However, it is not clear how widely adopted hypofractionation schedules will be.

“NRG Oncology RTOG 0415 was a randomized, phase III, noninferiority study comparing two fractionation schedules in men with low-risk prostate cancer: conventional radiotherapy (73 Gy in 41 fractions over 8.3 weeks) vs hypofractionation (70 Gy in 28 fractions over 5.6 weeks).1

“The study enrolled 1,115 patients with low-risk prostate cancer. No androgen suppression was given. Patients were stratified according to Gleason score 2–4 and Gleason score 5–6.”