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Highlights of the 2019 ANZUP conference

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ANZUP is a group of clinicians who perform research and clinical trials. They develop new tests and treatments for cancers such as prostate cancer. The 2019 ANZUP meeting brought together national and international experts to discuss the latest innovations and issues in research and clinical practice. The theme of this year’s meeting was Making Connections. This week’s research blog describes some of the meeting highlights for prostate cancer.

ANZUP is the Australian and New Zealand Urogenital and Prostate Cancer Trials Group. ANZUP’s mission is to conduct clinical trial research to improve treatment of bladder, kidney, testicular and prostate cancers.

PCFA staff recently attended the ANZUP Annual Scientific Meeting in Brisbane. ANZUP 2019 featured a symposium for PCFA’s Prostate Cancer Specialist Nurses, updates on the current treatments for different stages of prostate cancer, overviews of current and planned clinical trials and a community engagement forum.

Progress of ANZUP prostate cancer clinical trials

ANZUP have run and “co-badged” numerous prostate cancer clinical trials. PCFA partners with ANZUP to fund some of these trials. Updates on the current trials were given at the 2019 meeting:

ENZAMET Prof Ian Davis, Chair of ANZUP presented results from the successful ENZAMET clinical trial. These were recently announced and described in a research blog.

ProPSMA The ProPSMA trial was funded by PCFA through The Movember Foundation. This trial is testing whether having PSMA-PET scans after diagnosis with localised prostate cancer is useful as a first-line test for staging, prior to surgery or radiotherapy. The researchers predict that these PET scans will significantly change patient management. The ProPSMA trial has finished recruiting all participants and it’s hoped that the first results will be announced in 2020.

TheraP TheraP is a clinical trial testing a new treatment for men with metastatic castration resistant prostate cancer. PCFA have funded this clinical trial with help from partners such as The Movember Foundation. TheraP compares the radiation-based LuPSMA treatment to chemotherapy with cabazitaxel. The trial needs a total of 200 participants and is well ahead of schedule for recruitment. There are only about 20 participants needed to finish recruitment (as of mid-July 2019). More details about the TheraP trial are available here.

 

ANZUP 2019 featured presentations from many national and international experts on prostate cancer treatment. Among the presentation highlights were:

New directions for radiation therapy for metastatic prostate cancer.

A/Prof Phuoc Tran

A/Prof Phuoc Tran is a radiation oncologist visiting Australia from Johns Hopkins University in the US. He is also a researcher who leads a laboratory studying ways to improve radiotherapy. A/Prof Tran leads clinical trials to improve prostate cancer treatment. His presentation described the latest advances and new directions for radiotherapy for prostate cancer. He spoke at length about how metastasis starts and discussed the current understanding of oligometastatic prostate cancer – a stage where only a few small tumours can be seen on scans.

3393346103?profile=RESIZE_710xThe latest research has asked how metastatic prostate cancer starts. Results indicate that the theory that the prostate site seeds all new metastatic tumours seems to be incorrect. Some new tumours are seeded from existing metastatic tumours, not the original tumours in the prostate gland. There is even some evidence that cells move from the metastatic tumours back to the prostate gland.

A/Prof Tran’s talk included a discussion of SABR (Stereotactic ablative radiation therapy), also known as SBRT. SABR/SBRT uses highly focussed radiation concentrated on the tumours with a low dose to surrounding tissues. Sophisticated techniques are used to guide the accuracy of this new radiation treatment.

A/Prof Tran discussed his ongoing clinical trials testing SABR/SBRT for oligometastatic prostate cancer. The ORIOLE trial is recruiting men with oligometastatic prostate cancer who are being treated with hormone therapy (ADT). Two thirds will have SABR/SBRT aimed at their metastatic tumours and one third will not have this treatment. The researchers will ask whether SABR/SBRT slows progression of the cancer by 6 months. We look forward to results from this important clinical trial.

Whole blood androgen receptor-based gene-signature as a prognostic biomarker in metastatic castration resistant prostate cancer.

Dr Edmond Kwan

Dr Edmond Kwan is a medical oncologist at Monash Health in Victoria and a researcher at Monash University. He presented results from his successful project developing biomarkers for men with metastatic castration resistant prostate cancer. The aim of this study is to develop a biomarker as a prognostic test to predict outcomes. Such a test will help men with this late stage of prostate cancer to decide on treatments.

Dr Kwan’s research has developed a blood test to predict prostate cancer outcomes. His team has used blood samples from men with metastatic castration resistant prostate cancer. These samples were taken before men start treatment such as chemotherapy, Enzalutamide or Abiraterone. The genetic blood test measures the amounts of the AR-V7 mutant form of the testosterone receptor (Androgen Receptor) gene, as well as 3 other genes. The results from this study were very promising. The new test was a strong predictor of outcomes for men choosing different treatments when used for a specific group of patients.

In the future, this test needs to be validated in an independent group of patients and tested in a clinical trial. Dr Kwan hopes that it can be used by men choosing treatments as well as entering clinical trials.

 

Below the belt project research projects

ANZUP raises money for clinical trials via their Below the Belt Research Fund. In 2018, ANZUP funded six projects that directly addressed prostate cancer. Updates on these projects were presented at the ANZUP meeting.

Dr Ben Smith (presented by Orlando Rincones) - Development and piloting of a Question Prompt List (QPL) to aid informed treatment decision making in men diagnosed with localised prostate cancer

Men with localised prostate cancer face a difficult choice between treatments and active surveillance. They rely on information and recommendations from clinicians that may be incomplete or imbalanced. This research project is developing a Question Prompt list to help men get appropriate treatment information from their clinicians. It’s hoped that this list can improve the decision-making process.

Prof Suzanne Chambers (presented by A/Prof Nick Ralph) - QualTheraP: A nested, multi-perspective longitudinal qualitative study of participants in the TheraP trial3393348160?profile=RESIZE_710x

This study aims to understand the experiences of men with prostate cancer and their partners throughout their involvement in a clinical trial. The trial in question is TheraP, a test of a new radiation-based treatment called LuPSMA (described above). The researchers will interview men participating in the trial at the start, during the trial and after treatment. The interviews aim to understand men’s motivations in joining a clinical trial, their experiences on the trial and their needs.

Dr Camille Short - Why do men leave active surveillance? A mixed methods investigation examining factors contributing to adherence on active surveillance

Many men leave active surveillance to have treatment despite no increased growth of their prostate cancer. This study will examine the reasons why this is happening. The results will be used to develop supportive care for these men, to better address their needs.

A/Prof Craig Gedye - EnzAdapt: feasibility, acceptability and safety of adaptive dosing of enzalutamide in men with metastatic castrate-resistant prostate cancer

This project tests a new approach to treating metastatic prostate cancer that is progressing despite hormone therapy (metastatic castration resistant prostate cancer). The aim is to use Enzalutamide (Xtandi) with gaps in the treatment. This drug will be used for long enough to control the cancer, then stopped for a while. It’s hoped that this will be an effective way to hold the cancer back for longer, with fewer side effects.

Dr Edmond Kwan and Heidi Fettke (presented by Dr Edmond Kwan) - Application of a multi-gene prostate circulating tumour DNA (ctDNA) panel in men with metastatic hormone-sensitive prostate cancer (mHSPC)

This project will extend on the research of Dr Kwan, described above.

Dr Mark Stein - A pilot trial of Exendin PET scanning in metastatic castrate resistant prostate cancer

In a large diabetes clinical trial, it was found that less men taking a diabetes drug called Liraglutide developed prostate cancer, compared with those taking the placebo. Liraglutide is therefore a possible treatment for prostate cancer. Liraglutide acts via a cell-surface receptor that can be detected with a specific kind of PET scan, called Exendin PET. This project will use Exendin PET scans to look for the Liraglutide receptor on prostate tumours. If these receptors are found, this information will be used to design experiments using Liraglutide to treat prostate cancer.

 

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