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

The future of mCRPC treatment

Prof Li Ping Xie - Zhejiang University School of Medicine, China

Prof Paul de Souza - University of Western Sydney, Australia

Welcome to the third AC programme and I’m Dr Li Ping Xie from China and today, it’s my great honour to have Professor de Souza to take part in this expert-to-expert interview. Professor de Souza, could you please introduce yourself?

Yes, I’m Paul de Souza. I’m the Professor of Medical Oncology at the University of Western Sydney and I’m a practicing medical oncologist with clinical and research interests in prostate cancer.

The theme of today’s interview will focus on the future of mCRPC treatment. The first question is, how do you think current treatment choice will change over the next five years, Professor de Souza?

I think, the treatment choice is already expanding exponentially; so, in five years’ time, there may well be ten or 15 treatments available for men with metastatic castrate-resistant prostate cancer. And so, I think, the difficulty will be deciding which of these are the best or probably more appropriate for certain sectors and certain patients, patient profiles. I think, another challenge, also, will be sequencing them and deciding, in what order is the best to treat various patients.

And the second question I would like to ask you is what do you think is the future role of chemotherapy in the management of mCRPC?

Well, I’m a medical oncologist; I’ll always be biassed towards chemotherapy. I think, there always will be a role for chemotherapy for men with metastatic prostate cancer, the reason being that, is, I’m not sure that we are able to segment all patients with metastatic prostate cancer so that we find a suitable drug for each type of patient or each type of mutation; and, I think, also, the challenge will be that as men progress through each treatment, the prostate cancer becomes more undifferentiated, which means that, more than likely, it’ll behave more aggressively and require chemotherapy at some stage. So, my view is that men will eventually require some chemotherapy and so, I think, it will have a well-established role, even five years from now.

Okay. And, Professor de Souza, what treatment options would you consider for unfit or elderly patients? Because, for many patients with prostate cancer, they are elderly or unfit for chemotherapy.

I guess, that depends on what your definition of elderly is, right; if someone is older than the treating doctor, then they’re elderly. But as we all age, I think, you know, the incidence of prostate cancer, obviously, will increase, but the fitness of people, especially the elderly, will also improve and so, I suspect that the suitable patient now may well be less than 80, but in ten years’ time, we could have a proportion or a cadre of very fit, very active 80-year-olds or 85-year-olds and that will be a real problem because they will have a vast array of treatments available for them. However, to answer your question, I think, for patients who are unfit for chemotherapy, then clearly, oral treatments, preferably, and, more importantly, treatments with fewer side effects are most appropriate.

And the last question is, what would be the correct sequelae or combinations for the use of newly available agents, post-chemotherapy for the management of mCRPC in older patients?

I don't know that anybody has the answer to that and as the availability of these drugs becomes more widespread, I think, the combination and the sequences gets more and more complicated, clearly. So, I think, the only way forward, probably, is to develop more trials, particularly biomarker-driven type trials or personalised medicine, so-called personalised medicine, where certain biomarkers or genetic changes might predict that those men do better on a certain drug than another drug. But clearly, it will all require a very intense research effort and a lot of time, a lot of resources as well.

Okay. Thank you, Professor de Souza, for answering all these questions. Thank you very much.

That’s a pleasure. Thank you, Professor Li.