3rd Asia Pacific Prostate Cancer Conference (APPCC), Shanghai, China

mCRPC management in Taiwan

Prof Paul de Souza - University of Western Sydney, Australia

Dr Wayne Yen-Hwa Chang - Taipei Veterans General Hospital, Taiwan

Welcome to Shanghai, we are at the Ace Meeting, and today I am joined by Dr Wayne Chang from the Veterans Hospital in Taipei. Dr Chang, would you like to introduce yourself today please?

I am Dr Wayne Chang from Taipei Veterans General Hospital.  In our hospital we are one of the biggest medical centres in Taiwan, we have over 3000 beds and I am a urologist from our department.  In our department we have ten faculties.

So today we’re talking about metastatic castrate resistant prostrate cancer.  How do you define clinical progression in men with metastatic castrate resistant prostrate cancer?

The clinical progression in my point of view is soft tissue disease progression, either by radiology, valuation or bone scans, not to mention about PSA. I think both the biochemistry and clinical are so close. So first the patient will have PSA progression and then followed by clinical progression.

How much weight do you place on PSA progression in men with metastatic castrate resistant prostrate cancer?

In every case I think they will have PSA progression followed by clinical progression, so in the early stage we detect the PSA rising and then follow that six or eight months later, they will have clinical progression, so that’s very important.

What kind of things influence you to scan them or image them once men have PSA?

Oh yes, once the patient has clinical progression, I mean biochemistry progression, then I will order an image study to see if there’s anything changed or progression.

So leading on from that, what is the value of learning early that men are progressing clinically?

Well, based on the test result, either PSA or image studies, and also the symptoms, it’s very important.

And what role does early management of documenting progression play in the management of the disease?

Oh, that depends on one view, some of the patients may have symptoms and some may not. So AUA has six patient index, that’s very good guide for us to follow for treatment of this kind of progression.  Some of the patient may be minimal symptom or symptomatic, but they have disease progression.  Some may have bone pains, so depends on the clinical scenario, we have different treatment choice.

So in the era of genomic medicine, what role do biomarkers play in predicting response to treatment and advanced disease?

Yes, currently the only good markers is PSA, but we all know that PSA is not good enough, but we don’t have actually good biomarker, can be used clinically nowadays to guide our treatment choice, that PDSO, we still have a lot of things to do before we have a good biomarker to guide our treatment.

So Dr Chang, with the advent of the new drugs available for metastatic castrate resistant prostrate cancer, what happens in Taiwan?

The only available, I mean, our agents currently in Taiwan is abiraterone acetate. It just got its licence, I mean, the indication for patient with CRPC, but haven’t got insurance reimbursement, so if a patient needs this kind of medication, they have to pay from their own pocket.  Other new agents such as enzalutimide, we don’t have it available, not yet. We have some of the clinical trials ongoing, we can enrol our patients, if they cannot afford to pay for the drugs, then we can enrol them into new clinical trials.

Can you comment about the cost effectiveness of these new drugs and what you will see will happen in a place like Taiwan over the next five years?

These new agents look very promising.  Every one of them provide overall survival benefit, so I think in the near future, we will have them all available in Taiwan actually.

So you think they will get the reimbursement approved by the government?

Yes.

Do men travel overseas to pursue treatments?

Some of the patients may go overseas to get treatment, but it’s very difficult, not everyone can afford that. But we can help them to purchase some of the new agents overseas.

Thank you very much Dr Chang for talking with us today.

Thank you, it’s my honour to be here, thank you.