Interview recorded on April 2, 2020.
Dr. Moon: I see. Dr. Sartor, I’m going to jump to you. Of course, once the radiation piece either resolves or is not a factor here, usually we, the medical oncologists, we’re the one who kind of travel with this patient at that last piece of their journey.
Dr. Sartor: Yeah. You know, so again we’ve tried to prioritize the therapies that can keep patients out of the hospital and in, hopefully, a safe setting at home. The ability to give hormonal therapy is limited only by the need to monitor laboratories, and for things like abiraterone, I think all the oncologists would be familiar with the need to monitor potassium and liver functions. It turns out that there’s not a lot of laboratory monitoring for the enzalutamide. With apalutamide, there are the risks of the thyroid abnormalities and of course, fatigue and rash and other abnormalities, of course, to be monitored.
We’ve switched over to a lot of email and text, as well as phone calls. I realize that emails and texts are not reimbursable, and that is a concern for some, but if you really want to know the truth, my number one concern is taking care of patients. We do have a couple of patients that, I believe, the chemotherapy is absolutely required, and we are continuing to give chemotherapy where it is absolutely required, and we do have our infusion systems open, and of course, we’re monitoring patients carefully in that process.
With regard to things like PROVENGE, we’re simply not doing it right now. I don’t have any patients on radium right now, so I’ll simply say hormones are being minimized, and to the extent feasible, chemotherapy…excuse me, hormones are being maximized and chemotherapy is being minimized to the extent feasible, but we are continuing to use chemotherapy for those patients who I believe will benefit and do not have alternatives.
Dr. Silberstein: One thing I wanted to add, if I may jump in here for a second, Dr. Sartor. In an easier to control group, patients with…who are still hormone responsive and receiving ADT, at least at my VA, we generally do ADT every 6 months. We’ve moved all these patients to intermittent ADT so that they can get their labs checked more locally and avoid coming to the hospital, and I think that’s another mitigation strategy that we can use for some things.
Dr. Sartor: Well, you know, one factor, and we published on this as well as others, you know, that the utilization of the q. 6-month, q. 3-month, q. 4-month dosing, whatever it might be according to the FDA approval, that almost all the androgen suppression will outlast that interval. You know, if you give a 6-month injection, it actually takes you about 8 months on median to recur. So, a little bit of stretching out and monitoring the testosterone, you know, that’s probably just fine, too. And it has been used as a cost-conservation strategy, but right now, it might be used as a mitigation strategy as to exposing people to hospital and being around other sick patients.
Dr. Moon: What’s happening in your institution for those patients who have ran out of options who are looking at clinical trials? Maybe we’ll start with Dr. Harris.
Dr. Harris: Yeah. Well, so we in New Orleans at Tulane, we have continued to enroll appropriate patients on trials which are already approved and open, but we have taken a pause, as I understand it, and perhaps Dr. Sartor could add his comments, as well, when it comes to some of the trials that were in the pipeline, and that is a decision about resources, largely.
Dr. Moon: Okay.
Dr. Sartor: Yeah. If I may comment, the new trials are not being opened. That is resource intense. The trials that are already open, we actually have our research staff doing something very similar to what Kendra’s doing. We only have one research staff on at a time, so we’re running a skeleton sort of mission right now. We are continuing to put patients on clinical trial. I enrolled a patient on a clinical trial yesterday not involving chemotherapy, but it was one that provided him free drug, which was really quite essential. He had a rapid doubling time and a static CRPC, and we had the opportunity to provide him with free enzalutamide as part of a randomized trial, and the patient jumped at that opportunity, and we were able to enroll him on trial. So, it’s a little bit selective, but we are able to put patients on trial, just simply not open new trials.
Dr. Silberstein: And at the VA, we’ve been analyzing all of our trials on an individual basis. Trials that would put patients at an acceptable risk under normal circumstances may pose an increased risk due to the current COVID situation, and so we are reassessing individual trial and determining whether we want to continue. We’ve been, of course tele-remoting with our patients and checking in with them, making sure that they understand that they’re not being abandoned if they’re on an active clinical trial which we are no longer pursuing, but these are all localized prostate cancers, and that’s a very different scenario than Dr. Harris or Dr. Sartor are referring to.
Dr. Moon: Hey. Wow. I think all of us seem to be thinking along the same lines, some slight variation, but I don’t think we’re too far off, and ultimately, I think our mission is to just protect as many people as we’re able to. So, thank you so much, all three of you guys, for just joining me and letting me have a chance to ask some of the questions that we have here in the community when we’re taking care of the bulk of the patients, and I know they’re scared, and I’m sure they’re more than happy to hear that our leading institutions are thinking along the same lines. So, thank you so much, all three of us, all three of you guys, for joining me.
Dr. Silberstein: Thank you.
Dr. Sartor: Thank you. Thank you, Helen, and yeah, stay safe yourself because you know, one of the things we really have to do is to make sure that all the healthcare providers are available to take care of our patients, so be cautious.