PracticeUpdate: Oncology - Winter 2018

EXPERT OPINIONS 23

Dr. Shih: I think they potentially are because actual clinical care is nuanced and you have to individualize the patients, and you can’t just find one cookie cutter system to apply to all patients. Seeing these options in different studies done in a prospective study is very helpful and meaningful for Dr. Shih: And as a third study that was pre- sented, what I found particularly interesting was one on metastatic prostate cancer from Ottawa, Canada. This was a study where, upfront these metastatic prostate cancer patients are treated with an androgen dep- rivation therapy and that is the standard of care. But additionally, they looked to see who got local radiation therapy to the pros- tate, which is not standard in the US. I’m not particularly sure on the details. We’ll hear from the investigators how this came to be, but they found 105 patients who did get local prostate radiation ther- apy of at least 40 Gray in 15 fractions were the equivalent biologic dose and compared these with approximately 200 other patients who did not receive any radiation to the prostate. Amazingly, they patients and their providers. Dr. Haffizulla : Well, excellent.

The actual R0 resection was equivalent, approximately 90%, I believe, across all 3 arms. But what’s new at ASCO this year is you’re looking at the actual primary end- point of disease-free survival at 3 years and this is 495 patients, so it’s a large patient number and what we see is it’s equivalent. It’s roughly 76% to 78% across all 3 arms and also overall survival of 3-year end- point also excellent, 92% to 94% across all 3 arms. This is really giving providers opportuni- ties of options to present their patients. The standard of care, still the standard of care; 5-FU radiation works. I think the much higher success rate was with pathologic CR is compelling and we just don’t know yet because it’s just 3-year data at this point. Will FOLFOX added to the radiation trans- late to better disease-free survival, overall survival, or other endpoints in the years to come for these patients, and for the patients who can’t get radiation for what- ever reason? It’s not entirely unreasonable to do FOLFOX alone, since at least 3 years’ data, they do equivalently well with survival. Dr. Haffizulla: So, you consider that practice changing in some sense?

found a significant survival benefit in those patients who received local radiation ther- apy. Median survival 4 years, 48 months, compared to 29 months in those patients who did not receive radiation in addition to androgen deprivation therapy. This may be practice-changing. I do think it needs additional validation. There could be different reasons why these patients received radiation. It is in a retrospective setting, but it is similar to me in a sense to what we do for renal cell carcinoma where historically we only provide a systemic ther- apy for metastatic disease. But now we know palliative nephrectomy can be both of a survival benefit as well as a quality of life benefit to patients.

Dr. Haffizulla is the Assistant Dean of Community and Global Health at Nova Southeastern University’s College of Allopathic Medicine. She practices general internal medicine in Davie, Florida, within her own internal medicine concierge practice.

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VOL. 2 • NO. 3 • 2018