Interview recorded on April 2, 2020.
Dr. Moon: So, let’s go ahead and segue into the metastatic, as you were talking about systemic therapy. In there, there’s two different buckets. There’s a hormone-sensitive prostate cancer, in which over the last…gosh, it was, CHAARTED was 2015, I believe... so in the last 5 years, we have done a lot of work in early intensification, and I will certainly tell you, here at Kaiser, the idea of early intensification with chemo is just not attractive at the current time, and we are lucky enough to have other options. I think you’re saying the same thing. Is that correct?
Dr. Sartor: I am, Helen, and you know, the nice news is we have a multiplicity of FDA-approved drugs, abiraterone, apalutamide, enzalutamide, in the metastatic hormone-sensitive space. So, we don’t feel like we’re withholding any therapy that’s actually life-prolonging because we can provide that life-prolonging therapy with those FDA-approved agents.
Dr. Silberstein: Chemotherapy, you all are discouraging in the metastatic hormone-sensitive setting because chemotherapy is immunosuppressive, and in the current era, we do not want patients to undergo these immunosuppressive agents, whereas the other oral agents not only don’t require these patients from coming into the hospital repeatedly, but also are less immunosuppressive, maybe not at all, depending on that prednisone conversation Dr. Sartor had earlier.
Dr. Sartor: That’s correct, Jon, and you know, the febrile neutropenia is not particularly high with the CHAARTED regimen, but it does occur, and the frequent need for infusions in a setting that requires more interaction with other patients, with the nursing staff, is right now in my mind to be discouraged, particularly when we have options that are very reasonable.
Dr. Moon: I think...I’ve talked to several people, for this particular piece of the treatment bucket, the hormone sensitive, there’s very little argument, I would say, throughout the country, which is no chemo, keep them safe, keep them home, use the three approved endocrine therapy.