Apalutamide is a drug developed to treat non-metastatic castration-resistant prostate cancer. It works as a competitive antagonist of the androgen receptor by binding to it more efficiently than other drugs and preventing the receptor's nuclear localization. Clinical trials found apalutamide to be well tolerated and resulted in significant reductions in PSA levels in patients, demonstrating its robust anti-tumor activity for this cancer type.
This document summarizes treatment approaches for metastatic castration-resistant prostate cancer (mCRPC). It discusses definitions of CRPC and mechanisms of resistance. For mCRPC patients with PSADT >10 months and no symptoms, secondary hormonal therapies are recommended, while those with PSADT <10 months receive second-generation antiandrogens. Docetaxel remains first-line for symptomatic mCRPC, while abiraterone, enzalutamide, radium-223, and sipuleucel-T are also options. Detection of AR-V7 in circulating tumor cells may help determine if taxanes or AR-targeted therapies are most suitable. Ongoing treatment, monitoring of
Immunotherapy maintenence for advanced urothelial cancerChandan K Das
- JAVELIN Bladder 100 was a phase 3 trial investigating avelumab maintenance therapy after platinum-based chemotherapy in patients with advanced urothelial carcinoma.
- The trial found avelumab maintenance significantly improved overall survival compared to best supportive care alone, with a 31% reduction in risk of death. Progression-free survival was also significantly improved.
- Subgroup analyses found overall survival benefits were consistent across all patient subgroups, including those with PD-L1-negative tumors. Response rates were also higher with avelumab maintenance.
- The safety profile of avelumab was manageable, with most treatment-related adverse events being grade 1-2 in severity and no new safety signals
Optimizing Therapeutic Strategies in Castration-Resistant Prostate Canceri3 Health
This activity will discuss emerging efficacy and safety data on novel therapies for nmCRPC and mCRPC, strategies to manage adverse events, and the role of imaging studies and PSA testing in evaluating treatment response.
Apalutamide is a drug developed to treat non-metastatic castration-resistant prostate cancer. It works as a competitive antagonist of the androgen receptor by binding to it more efficiently than other drugs and preventing the receptor's nuclear localization. Clinical trials found apalutamide to be well tolerated and resulted in significant reductions in PSA levels in patients, demonstrating its robust anti-tumor activity for this cancer type.
This document summarizes treatment approaches for metastatic castration-resistant prostate cancer (mCRPC). It discusses definitions of CRPC and mechanisms of resistance. For mCRPC patients with PSADT >10 months and no symptoms, secondary hormonal therapies are recommended, while those with PSADT <10 months receive second-generation antiandrogens. Docetaxel remains first-line for symptomatic mCRPC, while abiraterone, enzalutamide, radium-223, and sipuleucel-T are also options. Detection of AR-V7 in circulating tumor cells may help determine if taxanes or AR-targeted therapies are most suitable. Ongoing treatment, monitoring of
Immunotherapy maintenence for advanced urothelial cancerChandan K Das
- JAVELIN Bladder 100 was a phase 3 trial investigating avelumab maintenance therapy after platinum-based chemotherapy in patients with advanced urothelial carcinoma.
- The trial found avelumab maintenance significantly improved overall survival compared to best supportive care alone, with a 31% reduction in risk of death. Progression-free survival was also significantly improved.
- Subgroup analyses found overall survival benefits were consistent across all patient subgroups, including those with PD-L1-negative tumors. Response rates were also higher with avelumab maintenance.
- The safety profile of avelumab was manageable, with most treatment-related adverse events being grade 1-2 in severity and no new safety signals
Optimizing Therapeutic Strategies in Castration-Resistant Prostate Canceri3 Health
This activity will discuss emerging efficacy and safety data on novel therapies for nmCRPC and mCRPC, strategies to manage adverse events, and the role of imaging studies and PSA testing in evaluating treatment response.
This document discusses locally advanced high risk prostate cancer and evolving treatment options. It provides an overview of risk stratification, guidelines for biopsy from the European Association of Urology, options for imaging with multiparametric MRI, and options for treatment including radical prostatectomy, radiation therapy, and hormonal therapy. New advances in radiation therapy include stereotactic body radiation therapy and hypofractionated regimens. Advances in hormonal therapy include gonadotropin-releasing hormone antagonists and oral options like relugolix. Neoadjuvant docetaxel chemotherapy is also discussed for high risk localized disease.
Advances in management of castration resistant prostate cancerAlok Gupta
Given this patient's advanced age and comorbidities, I would recommend abiraterone acetate as the second line treatment option post enzalutamide progression. Abiraterone has shown survival benefit with good tolerability in older patients with comorbidities in the COU-AA-301 trial. Cabazitaxel could be considered but may have higher toxicity risks in this patient. Close monitoring would be needed.
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
The Changing Role of PARP Inhibitors in the Treatment of Ovarian Cancerbkling
In recent years, researchers have been looking into using a class of drugs called PARP inhibitors to prevent the progression and recurrence of ovarian cancer. Dr. Kathleen Moore of Stephenson Cancer Center, Principal Investigator of the SOLO-1 trial, explains how the results of this trial may affect ovarian cancer patients and where research on ovarian cancer treatment is headed next.
This document discusses the management of biochemical recurrence after definitive therapy for localized prostate cancer. It defines biochemical recurrence after radical prostatectomy and radiation therapy. Imaging options for detecting recurrence like PET/CT, MRI, and prostate-specific membrane antigen (PSMA) PET are discussed. The document reviews treatment options for recurrence including salvage radiation therapy, androgen deprivation therapy, salvage surgery, cryotherapy, brachytherapy, and high-intensity focused ultrasound. Guidelines for imaging and treatment of recurrence are provided.
This document summarizes several androgen receptor-targeted agents (apalutamide, enzalutamide, darolutamide) approved for treatment of prostate cancer, including their indications, dosing, and common adverse events. It also describes ongoing clinical trials evaluating these and other agents (PARP inhibitors, immunotherapy) alone or in combination for metastatic castration-sensitive, non-metastatic castration-resistant, and metastatic castration-resistant prostate cancer. Many trials are investigating these novel approaches in patients with DNA damage repair defects.
Update on Management of Triple Negative Breast Cancerspa718
This document provides an update on the management of triple negative breast cancer from Dr. Banu Arun at MD Anderson Cancer Center. It discusses that triple negative breast cancer is a heterogeneous disease comprised of several molecular subtypes with different characteristics and potential treatment targets. Clinical trials exploring chemotherapy regimens, platinum agents, PARP inhibitors, anti-angiogenic drugs, and immunotherapies are summarized. Ongoing research aims to better define the subtypes in order to personalize treatment for triple negative breast cancer patients.
Prostate carcinoma- Castrate Resistant Prostate Cancer (crpc)GovtRoyapettahHospit
This document discusses castrate resistant prostate cancer (CRPC). It defines CRPC and outlines various treatment options including androgen receptor directed therapies like abiraterone and enzalutamide, cytotoxic chemotherapies like docetaxel and cabazitol, immunotherapies, and targeted therapies. It also discusses mechanisms of castration resistance like AR amplification and activation by alternative ligands.
The SOFT trial investigated the role of ovarian function suppression (OFS) and aromatase inhibitors (AIs) in premenopausal breast cancer patients. It found that adding OFS to tamoxifen (TAM) improved 5-year disease-free survival from 84.7% to 86.6%, though the difference was not statistically significant. The SOFT+TEXT analysis found that substituting exemestane for TAM when combined with OFS improved 5-year disease-free survival from 87.3% to 91.1%, with a statistically significant difference. For patients who received chemotherapy, exemestane+OFS provided an absolute 5-year breast cancer-free rate improvement of 3.
This document discusses various treatment options for prostate cancer based on risk level. For low risk prostate cancer with a life expectancy under 10 years, observation is recommended. For intermediate risk prostate cancer, options include radiation therapy with a short course of hormone therapy or surgery with radiation and hormone therapy if high risk features are present. For high risk prostate cancer, initial treatment involves radiation therapy with a long course of hormone therapy or surgery with radiation and long course hormone therapy if high risk features or positive lymph nodes are present. Very high risk prostate cancer may be treated with hormone therapy alone or similarly to metastatic disease.
This document summarizes current dilemmas in early management of castration-resistant prostate cancer (CRPC). It discusses definitions of CRPC and its natural history progression. Factors contributing to inevitable disease progression despite androgen deprivation therapy include alternate androgen biosynthesis, androgen receptor abnormalities, proliferation cascades, and changes in histology. Genetic alterations in prostate cancer like BRCA mutations are also reviewed. Recent positive clinical trial results establishing new standards of care for both chemo-naïve and post-docetaxel CRPC are highlighted. Optimal sequencing of available therapies remains an area of ongoing research due to heterogeneity in patient populations and lack of head-to-head trials.
This phase 3 randomized trial investigated the incorporation of bevacizumab and nonplatinum combination chemotherapy in the treatment of advanced cervical cancer. It found that the addition of bevacizumab to chemotherapy significantly improved median overall survival compared to chemotherapy alone, from 13.3 months to 16.8 months. Bevacizumab also significantly improved progression-free survival and response rates. The benefit was observed across patient subgroups and did not negatively impact quality of life. Higher rates of gastrointestinal fistulas and thromboembolic events occurred with bevacizumab. The trial demonstrated that bevacizumab provided meaningful clinical benefit when added to chemotherapy for advanced cervical cancer.
Neoadjuvant or adjuvant immunotherapy in melanoma stage iiiSameer Rastogi
The advent of neoadjuvant therapy in malignant melanoma might prove to be practice changing. Though still in research yet OPACIN and Neo OPACIN trials have unraveled the potential of neoadjuvant immunotherapy in malignant melanoma
The document summarizes several clinical trials related to prostate cancer treatment. It provides details on trials such as PIVOT, ProtecT, TAX327 which compared radical prostatectomy vs observation, active monitoring vs surgery or radiation, and docetaxel vs mitoxantrone for advanced prostate cancer. It also summarizes larger ongoing trials like STAMPEDE and LATITUDE that are evaluating multiple treatment strategies for high risk or metastatic prostate cancer.
NEOADJUVANT THERAPY IN PANCREATIC CANCER.pptxSujan Shrestha
1) Several studies provide evidence supporting the use of neoadjuvant therapy for resectable pancreatic cancer. The PREOPANC-1 trial found no survival benefit for neoadjuvant chemoradiotherapy compared to upfront surgery in resectable pancreatic cancer. However, the Prep-02/JSAP-05 and PACT-15 trials found significantly improved survival with neoadjuvant chemotherapy compared to upfront surgery.
2) Guidelines such as ESMO and NCCN provide classifications for resectability and recommend considering neoadjuvant therapy for resectable pancreatic cancer with certain high-risk features or comorbidities.
3) Potential advantages of neoadjuvant therapy include managing micro
1) The document discusses treatment strategies for metastatic colorectal cancer (mCRC), including the importance of multidisciplinary teams, sequencing of chemotherapy and targeted therapies, and continuing treatment beyond progression.
2) Key points addressed include using oxaliplatin or irinotecan as the chemotherapy backbone, adding targeted therapies like bevacizumab or anti-EGFR antibodies based on molecular markers, and exploring more intensive strategies like FOLFOXIRI for certain patients.
3) Maintaining quality of life across all treatment lines is emphasized as the overarching goal.
The document summarizes the treatment landscape for metastatic hormone-sensitive prostate cancer (mHSPC). It discusses several key trials that have established the benefit of primary intensification with the addition of docetaxel, abiraterone, enzalutamide, or apalutamide to androgen deprivation therapy (ADT). Trials like CHAARTED, LATITUDE, and STAMPEDE showed improved overall survival with these combinations compared to ADT alone. There is ongoing debate around the appropriate definition of high-volume versus low-volume disease and which patients most benefit from the triplet combination of ADT plus docetaxel plus a second agent. Overall, primary intensification beyond ADT alone is now
Metastatic castration-resistant prostate cancer (mCRPC) is an advanced form of prostate cancer that has spread to other organs and continues to progress despite hormone therapy. Current treatments aim to reduce testosterone levels, disrupt microtubules during cell division, activate the immune system, or use radiopharmaceuticals, but all have limitations like toxicity or development of resistance. Researchers are exploring new targets and combinations of drugs to block cancer progression and prolong survival for men with mCRPC, which remains largely incurable.
Adjuvant Endocrine Therapy For Postmenopausal Breast CancerEmad Shash
Questions Covered in the presentation:
• Should patients receive an AI or Tamoxifen?
• Should patients receive monotherapy (AI or Tamoxifen alone) or sequential
therapy using both?
• 5 vs 10 years of therapy?
• If More than 5 years of endocrine therapy, which class to be used
This document presents a case scenario for choosing the best management strategy for a 73-year-old male patient with hormone-naïve metastatic prostate cancer. The patient has bone metastases, a PSA of 115 ng/ml, and biopsy-confirmed Grade 4 prostate adenocarcinoma. Treatment options discussed include ADT alone, ADT plus abiraterone, ADT plus docetaxel, and newer approvals like apalutamide and enzalutamide. Key trials comparing these options are summarized. Factors to consider in choosing a treatment include availability, tolerability, differential toxicity profiles, and efficacy based on the patient's individual risk profile. For this patient who has completed ADT plus doc
Medical management of prostate cancer can include active surveillance, radiation therapy, surgery, hormone therapy, and chemotherapy depending on the cancer's risk level and stage. Investigations may involve PSA testing, biopsy, imaging, and disease staging. Androgen deprivation therapy is an important treatment option and can be accomplished through surgical or chemical castration. Docetaxel and cabazitaxel chemotherapy may provide benefits for advanced or metastatic disease.
This document discusses locally advanced high risk prostate cancer and evolving treatment options. It provides an overview of risk stratification, guidelines for biopsy from the European Association of Urology, options for imaging with multiparametric MRI, and options for treatment including radical prostatectomy, radiation therapy, and hormonal therapy. New advances in radiation therapy include stereotactic body radiation therapy and hypofractionated regimens. Advances in hormonal therapy include gonadotropin-releasing hormone antagonists and oral options like relugolix. Neoadjuvant docetaxel chemotherapy is also discussed for high risk localized disease.
Advances in management of castration resistant prostate cancerAlok Gupta
Given this patient's advanced age and comorbidities, I would recommend abiraterone acetate as the second line treatment option post enzalutamide progression. Abiraterone has shown survival benefit with good tolerability in older patients with comorbidities in the COU-AA-301 trial. Cabazitaxel could be considered but may have higher toxicity risks in this patient. Close monitoring would be needed.
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
The Changing Role of PARP Inhibitors in the Treatment of Ovarian Cancerbkling
In recent years, researchers have been looking into using a class of drugs called PARP inhibitors to prevent the progression and recurrence of ovarian cancer. Dr. Kathleen Moore of Stephenson Cancer Center, Principal Investigator of the SOLO-1 trial, explains how the results of this trial may affect ovarian cancer patients and where research on ovarian cancer treatment is headed next.
This document discusses the management of biochemical recurrence after definitive therapy for localized prostate cancer. It defines biochemical recurrence after radical prostatectomy and radiation therapy. Imaging options for detecting recurrence like PET/CT, MRI, and prostate-specific membrane antigen (PSMA) PET are discussed. The document reviews treatment options for recurrence including salvage radiation therapy, androgen deprivation therapy, salvage surgery, cryotherapy, brachytherapy, and high-intensity focused ultrasound. Guidelines for imaging and treatment of recurrence are provided.
This document summarizes several androgen receptor-targeted agents (apalutamide, enzalutamide, darolutamide) approved for treatment of prostate cancer, including their indications, dosing, and common adverse events. It also describes ongoing clinical trials evaluating these and other agents (PARP inhibitors, immunotherapy) alone or in combination for metastatic castration-sensitive, non-metastatic castration-resistant, and metastatic castration-resistant prostate cancer. Many trials are investigating these novel approaches in patients with DNA damage repair defects.
Update on Management of Triple Negative Breast Cancerspa718
This document provides an update on the management of triple negative breast cancer from Dr. Banu Arun at MD Anderson Cancer Center. It discusses that triple negative breast cancer is a heterogeneous disease comprised of several molecular subtypes with different characteristics and potential treatment targets. Clinical trials exploring chemotherapy regimens, platinum agents, PARP inhibitors, anti-angiogenic drugs, and immunotherapies are summarized. Ongoing research aims to better define the subtypes in order to personalize treatment for triple negative breast cancer patients.
Prostate carcinoma- Castrate Resistant Prostate Cancer (crpc)GovtRoyapettahHospit
This document discusses castrate resistant prostate cancer (CRPC). It defines CRPC and outlines various treatment options including androgen receptor directed therapies like abiraterone and enzalutamide, cytotoxic chemotherapies like docetaxel and cabazitol, immunotherapies, and targeted therapies. It also discusses mechanisms of castration resistance like AR amplification and activation by alternative ligands.
The SOFT trial investigated the role of ovarian function suppression (OFS) and aromatase inhibitors (AIs) in premenopausal breast cancer patients. It found that adding OFS to tamoxifen (TAM) improved 5-year disease-free survival from 84.7% to 86.6%, though the difference was not statistically significant. The SOFT+TEXT analysis found that substituting exemestane for TAM when combined with OFS improved 5-year disease-free survival from 87.3% to 91.1%, with a statistically significant difference. For patients who received chemotherapy, exemestane+OFS provided an absolute 5-year breast cancer-free rate improvement of 3.
This document discusses various treatment options for prostate cancer based on risk level. For low risk prostate cancer with a life expectancy under 10 years, observation is recommended. For intermediate risk prostate cancer, options include radiation therapy with a short course of hormone therapy or surgery with radiation and hormone therapy if high risk features are present. For high risk prostate cancer, initial treatment involves radiation therapy with a long course of hormone therapy or surgery with radiation and long course hormone therapy if high risk features or positive lymph nodes are present. Very high risk prostate cancer may be treated with hormone therapy alone or similarly to metastatic disease.
This document summarizes current dilemmas in early management of castration-resistant prostate cancer (CRPC). It discusses definitions of CRPC and its natural history progression. Factors contributing to inevitable disease progression despite androgen deprivation therapy include alternate androgen biosynthesis, androgen receptor abnormalities, proliferation cascades, and changes in histology. Genetic alterations in prostate cancer like BRCA mutations are also reviewed. Recent positive clinical trial results establishing new standards of care for both chemo-naïve and post-docetaxel CRPC are highlighted. Optimal sequencing of available therapies remains an area of ongoing research due to heterogeneity in patient populations and lack of head-to-head trials.
This phase 3 randomized trial investigated the incorporation of bevacizumab and nonplatinum combination chemotherapy in the treatment of advanced cervical cancer. It found that the addition of bevacizumab to chemotherapy significantly improved median overall survival compared to chemotherapy alone, from 13.3 months to 16.8 months. Bevacizumab also significantly improved progression-free survival and response rates. The benefit was observed across patient subgroups and did not negatively impact quality of life. Higher rates of gastrointestinal fistulas and thromboembolic events occurred with bevacizumab. The trial demonstrated that bevacizumab provided meaningful clinical benefit when added to chemotherapy for advanced cervical cancer.
Neoadjuvant or adjuvant immunotherapy in melanoma stage iiiSameer Rastogi
The advent of neoadjuvant therapy in malignant melanoma might prove to be practice changing. Though still in research yet OPACIN and Neo OPACIN trials have unraveled the potential of neoadjuvant immunotherapy in malignant melanoma
The document summarizes several clinical trials related to prostate cancer treatment. It provides details on trials such as PIVOT, ProtecT, TAX327 which compared radical prostatectomy vs observation, active monitoring vs surgery or radiation, and docetaxel vs mitoxantrone for advanced prostate cancer. It also summarizes larger ongoing trials like STAMPEDE and LATITUDE that are evaluating multiple treatment strategies for high risk or metastatic prostate cancer.
NEOADJUVANT THERAPY IN PANCREATIC CANCER.pptxSujan Shrestha
1) Several studies provide evidence supporting the use of neoadjuvant therapy for resectable pancreatic cancer. The PREOPANC-1 trial found no survival benefit for neoadjuvant chemoradiotherapy compared to upfront surgery in resectable pancreatic cancer. However, the Prep-02/JSAP-05 and PACT-15 trials found significantly improved survival with neoadjuvant chemotherapy compared to upfront surgery.
2) Guidelines such as ESMO and NCCN provide classifications for resectability and recommend considering neoadjuvant therapy for resectable pancreatic cancer with certain high-risk features or comorbidities.
3) Potential advantages of neoadjuvant therapy include managing micro
1) The document discusses treatment strategies for metastatic colorectal cancer (mCRC), including the importance of multidisciplinary teams, sequencing of chemotherapy and targeted therapies, and continuing treatment beyond progression.
2) Key points addressed include using oxaliplatin or irinotecan as the chemotherapy backbone, adding targeted therapies like bevacizumab or anti-EGFR antibodies based on molecular markers, and exploring more intensive strategies like FOLFOXIRI for certain patients.
3) Maintaining quality of life across all treatment lines is emphasized as the overarching goal.
The document summarizes the treatment landscape for metastatic hormone-sensitive prostate cancer (mHSPC). It discusses several key trials that have established the benefit of primary intensification with the addition of docetaxel, abiraterone, enzalutamide, or apalutamide to androgen deprivation therapy (ADT). Trials like CHAARTED, LATITUDE, and STAMPEDE showed improved overall survival with these combinations compared to ADT alone. There is ongoing debate around the appropriate definition of high-volume versus low-volume disease and which patients most benefit from the triplet combination of ADT plus docetaxel plus a second agent. Overall, primary intensification beyond ADT alone is now
Metastatic castration-resistant prostate cancer (mCRPC) is an advanced form of prostate cancer that has spread to other organs and continues to progress despite hormone therapy. Current treatments aim to reduce testosterone levels, disrupt microtubules during cell division, activate the immune system, or use radiopharmaceuticals, but all have limitations like toxicity or development of resistance. Researchers are exploring new targets and combinations of drugs to block cancer progression and prolong survival for men with mCRPC, which remains largely incurable.
Adjuvant Endocrine Therapy For Postmenopausal Breast CancerEmad Shash
Questions Covered in the presentation:
• Should patients receive an AI or Tamoxifen?
• Should patients receive monotherapy (AI or Tamoxifen alone) or sequential
therapy using both?
• 5 vs 10 years of therapy?
• If More than 5 years of endocrine therapy, which class to be used
This document presents a case scenario for choosing the best management strategy for a 73-year-old male patient with hormone-naïve metastatic prostate cancer. The patient has bone metastases, a PSA of 115 ng/ml, and biopsy-confirmed Grade 4 prostate adenocarcinoma. Treatment options discussed include ADT alone, ADT plus abiraterone, ADT plus docetaxel, and newer approvals like apalutamide and enzalutamide. Key trials comparing these options are summarized. Factors to consider in choosing a treatment include availability, tolerability, differential toxicity profiles, and efficacy based on the patient's individual risk profile. For this patient who has completed ADT plus doc
Medical management of prostate cancer can include active surveillance, radiation therapy, surgery, hormone therapy, and chemotherapy depending on the cancer's risk level and stage. Investigations may involve PSA testing, biopsy, imaging, and disease staging. Androgen deprivation therapy is an important treatment option and can be accomplished through surgical or chemical castration. Docetaxel and cabazitaxel chemotherapy may provide benefits for advanced or metastatic disease.
This document discusses the management of intermediate and high risk prostate cancer. It begins by providing background on prostate cancer epidemiology and risk stratification. It then covers various treatment options including observation, active surveillance, radical prostatectomy, radiotherapy, and androgen deprivation therapy. Several studies comparing the efficacy of radiotherapy alone versus radiotherapy with short or long-term ADT are summarized. For intermediate risk prostate cancer, the document recommends 4-6 months of ADT with radiotherapy based on trial results. For high risk prostate cancer, 2-3 years of ADT with radiotherapy is recommended.
Prostate Cancer - Current Approach and Future Perspective in Castration-Resis...KCR
Prostate carcinoma is one of the most commonly diagnosed solid tumours in males worldwide. Selection of the treatment method is strictly dependent upon disease stage and the patient’s age. Availability of diagnostic tests is constantly increasing in clinical practice, allowing early diagnosis and better chances for complete and permanent recovery. In the case of locally advanced prostate carcinoma, radical surgery or radiotherapy is considered as the most effective therapeutic approach, whereas in metastatic prostate carcinoma, hormone therapy or androgen deprivation therapy (ADT) is the primary therapeutic option. Moreover, increased use of chemotherapy with docetaxel and cabazitaxel in clinical practice has resulted in better prognosis for patients in this advanced stage of the disease.
The biggest challenge for doctors and patients remains the treatment of hormone-resistant carcinoma (which very often is also metastatic). Concerns of today’s medicine regarding effective therapies for this type of disease have recently led to a significant increase in the number of papers/studies on new-generation biological treatments.
This document discusses prostate cancer, including:
1. It is the second most common cancer in men and the second leading cause of cancer death in men. Rates are closely related to age and vary geographically.
2. Treatment depends on risk level, ranging from active surveillance for very low risk to radiation therapy or prostatectomy for low risk to radiation plus long-term androgen deprivation therapy for high risk.
3. For metastatic hormone-sensitive prostate cancer, adding docetaxel chemotherapy to initial androgen deprivation therapy improves progression-free and overall survival compared to androgen deprivation therapy alone.
Role of radiotherapy in prostate cancer.pptxAtulGupta369
This document discusses radiation therapy guidelines for prostate cancer treatment based on risk stratification. For low-risk prostate cancer, active surveillance is recommended. For intermediate-risk disease, radiation therapy alone or surgery are equally effective with comparable long-term tumor control. For high-risk or locally advanced prostate cancer, long-term androgen deprivation therapy combined with radiation therapy improves survival outcomes. The document also reviews evidence on dose escalation, which has demonstrated improved biochemical control and reduced metastases and disease-specific mortality compared to lower radiation doses.
This document summarizes guidelines and treatment recommendations for prostate cancer management. It discusses risk stratification and different treatment options including active surveillance, surgery, radiation therapy using brachytherapy or external beam radiation, and androgen deprivation therapy. Treatment selection is based on patient life expectancy, tumor characteristics, and availability of local therapies. Side effects of different treatments are also reviewed.
Presentation is highlighting the integration of different modalities in the management of locally advanced and metastatic prostate cancer pointing to the proven values of adding chemotherapy. A special note has been made to oligometastatic disease.
metastatic prostate cancer management options69pjzhtrqr
1) The document discusses treatment options for metastatic castrate-sensitive prostate cancer (mCSPC) and metastatic castrate-resistant prostate cancer (mCRPC).
2) For mCSPC, adding androgen receptor pathway inhibitors (ARPIs) or docetaxel to androgen deprivation therapy (ADT) improves survival compared to ADT alone. Patients with high volume disease may benefit from triplet therapy with ADT, docetaxel and an ARPI.
3) For mCRPC, multiple lines of ARPIs, chemotherapy and other targeted drugs have become available to treat progression and improve survival. Sequencing of these options depends on prior therapies received and patient characteristics.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Trattamenti ipofrazionati ed ipofrazionati-accelerati: nuove possibilità di prevenzione e trattamento della tossicità acuta e tardiva
The document summarizes the results of two randomized controlled trials that assessed the efficacy of adding abiraterone acetate and prednisolone alone or with enzalutamide to androgen deprivation therapy (ADT) in men with high-risk non-metastatic prostate cancer. The trials found that metastasis-free survival was significantly longer in patients who received combination therapy with abiraterone acetate and prednisolone compared to ADT alone. There was no significant difference found between adding enzalutamide or not. The interpretation is that combination therapy is associated with higher rates of preventing cancer spread compared to ADT alone for men with high-risk non-metastatic prostate cancer.
The document discusses the role of radiation therapy in treating oligometastatic prostate cancer, noting that radiation can potentially achieve durable responses or even cure in some cases when metastases are limited. It reviews definitions of oligometastatic prostate cancer, the rationale for local and metastasis-directed radiation therapy, clinical evidence from studies on the use of external beam radiation therapy and stereotactic body radiation therapy to treat the primary tumor and metastases, and outcomes from these studies including local control rates, progression-free survival, and overall survival. The document concludes that radiation therapy plays an important role in the treatment of oligometastatic prostate cancer.
This document discusses a trial investigating the role of local radiation therapy for metastatic prostate cancer. The main findings were:
1. No overall survival benefit was seen with radiation therapy, but survival improved in patients with low metastatic burden.
2. Failure-free survival improved with radiation therapy overall and in the low metastatic burden group.
3. Adverse effects from radiation therapy were modest.
The trial provides evidence that radiation therapy to the prostate improves outcomes for men with metastatic prostate cancer who have a low metastatic burden and does not negatively impact side effects.
This document discusses stereotactic body radiation therapy (SBRT) for head and neck cancers. It provides an overview of SBRT indications, efficacy, toxicity profiles, quality of life outcomes, fractionation schedules, target definition, constraints, and the role of cetuximab. Several studies on SBRT for recurrent head and neck cancers, primary cancers metastatic to the head and neck region, and target volume delineation are summarized. Toxicities are generally low but carotid blowout syndrome remains a concern, especially for tumors adjacent to carotid arteries.
1) The PORTEC-1 and PORTEC-2 trials compared pelvic radiotherapy to no additional treatment or vaginal brachytherapy for patients with endometrial carcinoma. PORTEC-1 found pelvic radiotherapy reduced vaginal recurrence while PORTEC-2 found vaginal brachytherapy achieved excellent vaginal control with fewer side effects compared to pelvic radiotherapy.
2) The PORTEC-3 trial randomized 686 patients with high risk endometrial cancer to chemoradiotherapy or radiotherapy alone. It found chemoradiotherapy improved failure-free survival compared to radiotherapy alone, especially for stage III patients, but with increased toxicity.
3)
Prostate cancer is the most common cancer among men. It develops in the prostate gland. Some key risk factors include age, family history, and ethnicity. Staging of prostate cancer involves determining the extent of spread using the TNM system. Treatment options depend on staging and include active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy. Common side effects of treatment include erectile dysfunction, urinary incontinence, and loss of sexual desire. Nursing care focuses on managing side effects, preventing infections, maintaining skin integrity, and providing psychosocial support.
Locally advanced and metastatic prostate cancer can be treated with surgery, radiation therapy, hormone therapy, chemotherapy, or a combination. For locally advanced disease, short-term and long-term hormone therapy combined with radiation therapy improves outcomes. Adjuvant radiation after prostatectomy improves survival for high-risk patients. Advanced disease is treated by depleting androgens through surgical or medical castration. Newer agents like abiraterone, enzalutamide, radium-223, cabazitaxel, and sipuleucel-T provide additional treatment options.
This document discusses the management of carcinoma of the esophagus. It begins by outlining treatment approaches for localized versus metastatic disease, including definitive and palliative therapies. It then reviews the evolution of esophageal cancer treatment, including non-surgical approaches using radiation therapy alone or combined modality therapy, as well as surgical treatments. Several studies evaluating different treatment regimens are summarized, including the benefits of concurrent chemoradiation therapy over radiation alone. The role of preoperative chemoradiation is discussed. Techniques for radiation therapy delivery are also outlined. The document concludes by discussing palliative care approaches for esophageal cancer patients.
1) Post-operative radiotherapy (PORT) can reduce the risk of prostate cancer recurrence after radical prostatectomy for patients with adverse features like positive surgical margins or extracapsular extension.
2) Large randomized trials have shown that adjuvant radiotherapy (ART) within 6 months of surgery improves outcomes compared to observation or early salvage radiotherapy initiated at first signs of recurrence.
3) Salvage radiotherapy is an option for patients with rising PSA after surgery but no metastases, and can improve biochemical progression-free survival and cancer-specific survival when initiated promptly at low PSA levels.
Similar to Apalutamide in metastatic castration resistant prostate cancer (20)
Types of immunotherapy
Oncology
cancer vaccines
adoptive T cell transfer
oncolytic viruses
monoclonal antibodies
cytokine
treatment of cancer with immunotherapy
1) High grade gliomas include grade III anaplastic astrocytomas, anaplastic oligodendrogliomas, and grade IV glioblastomas.
2) The standard of care for glioblastoma is maximal safe surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide chemotherapy. Molecular markers like MGMT promoter methylation and IDH1 mutation provide prognostic information.
3) For anaplastic gliomas, the treatment involves surgical resection followed by radiotherapy. For anaplastic gliomas with 1p/19q codeletion, PCV chemotherapy is given before or after radiotherapy based on trials showing improved outcomes.
Preoperative radiotherapy and surgery rectal cancers: optimal intervalGaurav Kumar
Preoperative radiotherapy and surgery rectal cancers: optimal interval between neoadjuvant radiotherapy/chemotherapy and surgery, evidence based approach
1) The document discusses treatment guidelines and radiation therapy for malignant parotid gland tumors. It outlines the workup, treatment algorithm, indications for postoperative radiation, and clinical target volume definition.
2) Recommendations include radiation therapy for T3/T4 tumors, incomplete resection, high grade histology, recurrent disease, and node-positive disease. The clinical target volume covers the parotid bed and neck lymph nodes.
3) Guidelines provide organ at risk contours and trial management group recommendations on radiation doses and volumes based on tumor and node characteristics. Elective neck irradiation is advised for high grade tumors, T3/T4 disease, and certain histologies.
The CLEOPATRA trial was a phase III randomized controlled trial that compared the efficacy and safety of pertuzumab, trastuzumab, and docetaxel versus placebo, trastuzumab, and docetaxel in patients with previously untreated HER2-positive metastatic breast cancer. The study found that adding pertuzumab to trastuzumab and docetaxel significantly extended progression-free survival by 6 months and improved overall response rates compared to the placebo group. Overall survival was also improved with the pertuzumab regimen. While rates of adverse events were similar between the groups, the pertuzumab regimen represented a substantial improvement over the standard of care.
Low grade glioma evidence based managementGaurav Kumar
Management of low grade gliomas (LGG) focuses on the WHO grading system and risk stratification. Current trends include:
1. Immediate postoperative radiotherapy (PORT) for high risk LGG with residual tumor >1cm, preop size >4cm, or age >40 based on improved progression free survival shown in clinical trials.
2. A PORT dose of 54Gy in 30 fractions is recommended based on Phase III trials showing no benefit to higher doses.
3. Adjuvant chemotherapy like temozolomide may be considered for high risk patients, especially those with 1p/19q codeletions and IDH1/2 mutations, though radiotherapy remains standard of
1) This study compared parotid sparing intensity modulated radiation therapy (IMRT) to conventional radiation therapy in patients with head and neck cancer.
2) It found significantly lower rates of grade 2 or worse xerostomia at 1 and 2 years for patients receiving IMRT compared to conventional radiation.
3) IMRT also resulted in improved saliva flow and quality of life scores compared to conventional radiation with comparable overall survival and progression-free survival between the two groups.
Tumor lysis syndrome and hypercalcemia of malignancyGaurav Kumar
This document discusses hypercalcemia and tumor lysis syndrome. It defines hypercalcemia as calcium levels above normal physiological range. The main causes of hypercalcemia include parathyroid disorders, malignancy, vitamin D abnormalities, and renal failure. Symptoms range from mild to severe depending on calcium level. Tumor lysis syndrome occurs when large numbers of cancer cells break down rapidly, releasing electrolytes. This can cause hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia, potentially leading to renal failure. The document outlines evaluation, treatment and prevention of both conditions.
Cancer biology senescence & imortalisationGaurav Kumar
This document discusses tumor suppressor mechanisms and senescence. It notes that 1% of neonatal cord blood contains malignant clones and 1/3 of adults possess an IgH-BCL2 translocation responsible for follicular leukemia. Senescence is a process of permanent growth arrest in response to telomere erosion, DNA damage, or oncogene activation. Chromosome 9p21 contains the INK4a/ARF/INK4b locus that encodes the p16, p15, and ARF proteins involved in senescence. Telomeres form protective T-loops at chromosomal ends to prevent DNA damage. NUTLINS and DNA methyltransferase inhibitors can reactivate p53 and p15/
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
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This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
3. ▪ The initial treatment for metastatic prostate cancer: Androgen-
deprivation therapy (ADT) through medical or surgical castration.
▪ High-risk or high-volume disease: ADT with either abiraterone
acetate plus prednisone or docetaxelⁱ…..longer survival.
▪ Patient age, coexisting conditions, extent of disease, and
preferences may affect decisions to initiate chemotherapy such as
docetaxel.
▪ Coadministration of prednisone to prevent increases in corticotropin and
may cause adverse events related to mineralocorticoid excess and liver
toxicity.
Introduction
ⁱJames ND, Sydes MR, Clarke NW, et al. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate
cancer (STAMPEDE).
Kassem L, Shohdy KS, Abdel-Rahman O. Abiraterone acetate/androgen deprivation therapy combination versus docetaxel/ androgen
deprivation therapy combination in advanced hormone-sensitive prostate cancer: a network meta-analysis on safety and efficacy.
4. ▪ Direct inhibition of the androgen receptor with ADT: Provide
complete blockade of androgen signaling than ADT
alone…improved patient outcomes.
▪ The limitations of first-generation AR antagonists:
i) weak affinity for the AR
ii) potential for agonist activity
٭Benefit of adding an AR antagonist to castration has not consistently
demonstrated an OS benefit in randomized trials in this patient
population, a large meta-analysis of 27 trials did suggest a 3% OS
improvement of CAB compared with monotherapy
▪ Apalutamide: 2nd genaration oral nonsteroidal antiandrogen agent
that binds directly to the ligand-binding domain of the androgen
receptor.
▪ Approved in the United States and European Union for the
treatment of patients with nonmetastatic, castration-resistant
prostate cancer.
8. ▪ TITAN trial: Phase 3, randomized, double-blind, placebo-controlled,
multinational trial.
▪ The trial was designed by the sponsor, Janssen Research & Development.
▪ Conducted at 260 sites in 23 countries.
▪ Randomisation (15/12/15 to 25/7/17): 1:1 ratio to receive apalutamide
(240 mg) or matched placebo administered orally once daily, in addition
to continuous ADT.
▪ Stratification:
1) Gleason score at diagnosis (≤7 vs. >7)
2) Geographic region (North America and European Union vs. all other)
3) Previous treatment with docetaxel (yes vs. no).
Methods
9. ▪ Documented adenocarcinoma of the prostate and distant metastatic disease
documented on the basis of at least one lesion on bone scanning, with or without
visceral or lymph-node involvement.
▪ ECOG 0 or 1.
▪ Patients were castration sensitive (i.e., patients were not receiving ADT at the time of
disease progression).
▪ Previous treatment
1) Previous docetaxel (maximum of six cycles, with no evidence of progression during
treatment or before randomization),
2) ADT for ≤ 6 months for metastatic, castration-sensitive prostate cancer,
3) ADT for ≤ 3 years for localized prostate cancer, one course of radiation or surgical therapy
for symptoms associated with metastatic disease, and other localized treatments completed
at least 1 year before randomization.
▪ Patients with severe angina, myocardial infarction, congestive heart failure, arterial or
venous thromboembolic events, a history of or predisposition to seizure, or recent
ventricular arrhythmias were excluded.
Eligibility
10. Primary end points
1) Radiographic progression–free survival
(Radiographic progression–free survival was defined as the time from randomization to first
imaging based documentation of progressive disease or death, whichever occurred first )
2) Overall survival
(Overall survival was defined as the time from randomization to the date of death from any
cause)
Secondary end points
1) Time to cytotoxic chemotherapy
2) Time to pain progression
3) Time to chronic opioid use
4) Time to skeletal-related event
٭Definition of high-volume disease was adapted from the CHAARTED trial: Visceral
metastases and at least one bone lesion, or at least four bone lesions with at least one
outside the axial skeleton.
Methods cont.
11. Efficacy : RECIST, version 1.1, with the use of CT or MRI of the
chest, abdomen, and pelvis during screening (≤6 weeks before
randomization) and with the use of bone scanning during cycles 3
and 5 and every fourth cycle thereafter.
Adverse events were assessed monthly and graded according to
National Cancer Institute CTCAE, version 4.0.3.
Methods cont.
12. Statistics
Radiographic progression– free survival
Overall type I error of 5% was planned. A total of 368 events of radiographic
progression were required to provide at least 85% power to detect a hazard
ratio of 0.67 with a two-tailed significance level of 0.005.
Final overall survival analysis
410 deaths were required to provide approximately 80% power to detect a
hazard ratio of 0.75 with a two-tailed significance level of 0.045.
٭Two interim analyses were planned for overall survival.
٭Kaplan–Meier product-limit method used to estimate time-to-event
variables.
٭Cox proportional-hazards model were used determine hazard ratios and
associated confidence intervals.
Methods cont.
20. Discussion
٭Apalutamide plus ADT resulted in significantly longer overall survival
and radiographic progression–free survival than placebo plus ADT.
٭Secondary and exploratory end points also favored apalutamide
treatment, including the time to cytotoxic chemotherapy and second
progression-free survival.
٭Apalutamide plus ADT also resulted in a higher percentage of
patients in whom undetectable PSA levels were achieved and a
longer time to PSA progression than placebo plus ADT.
٭The incidence of high-grade and serious adverse events did not
differ substantially between the apalutamide group and the placebo
group.
21. ٭Rash with apalutamide was common and was typically managed with
antihistamines and topical glucocorticoids, dose interruption, and dose
reduction.
٭Incidence of hypertension was lower and of ischemic heart disease was
higher in the apalutamide group in the TITAN trial than in the SPARTAN
trial.
٭Health-related quality of life in the TITAN trial was also preserved, with no
substantial difference between the two groups.
٭In conclusion, in the TITAN trial involving patients, including those with
high-volume or low-volume disease, previous docetaxel use, previous
treatment for localized disease, and previously or newly diagnosed disease,
apalutamide plus ADT resulted in significantly longer overall survival and
radiographic progression–free survival than placebo plus ADT.
Discussion cont.