{"id":1360,"date":"2017-09-12T12:33:51","date_gmt":"2017-09-12T16:33:51","guid":{"rendered":"https:\/\/www.bu.edu\/shipley\/?p=1360"},"modified":"2017-09-15T10:31:22","modified_gmt":"2017-09-15T14:31:22","slug":"sometimes-more-is-better","status":"publish","type":"post","link":"https:\/\/www.bu.edu\/shipley\/2017\/09\/12\/sometimes-more-is-better\/","title":{"rendered":"Sometimes MORE is better"},"content":{"rendered":"

When given the option of another piece of cake, most toddlers will automatically respond with more cake, because more is better, right?\u00a0 In medicine sometimes more is better, and sometimes it\u2019s not.<\/p>\n

Recently published in the New England Journal of Medicine<\/em> (July 27, 2017)1,2<\/sup> were two large clinical trials looking at the effectiveness of adding two medications to the standard backbone of prostate cancer treatment. They are abiraterone acetate (Zytiga\u00ae) and prednisone (a steroid), which lower androgens in a man\u2019s body. An androgen is a hormone and testosterone is an example of an androgen.<\/p>\n

This \u201ccocktail\u201d of treatment improved survival more than a single drug in both men who had cancer that spread to other parts of their body at the time of diagnosis as well as men whose cancer was still localized in the prostate, but was at high risk of coming back after radiation therapy.\u00a0 These findings reinforce what researchers have seen over the past two years: for certain patients, combining different types of treatments early on in the disease works better.<\/p>\n

Prostate cancer has been treated effectively with what many people call hormone therapy<\/em> for many years. \u00a0These treatments use drugs that lower the body\u2019s androgen levels. This remains an essential part of therapy for many men.\u00a0\u00a0 Some examples of drugs that do this are leuprolide acetate (Lupron\u00ae), goserelin acetate (Zoledex\u00ae), triptorelin pamoate (Trelstar\u00ae) or degarelix (Firmagon\u00ae).\u00a0 These drugs are called androgen deprivation therapies. There is also a type of surgery called orchiectomy that does the same thing.<\/p>\n

However this approach only tackles the testosterone that comes from a man\u2019s testicles.\u00a0 We now know that hormones from a man\u2019s adrenal glands (little glands that sit on top of the kidneys) and hormones that the tumor makes itself are also important. Abiraterone and prednisone are a medicine combination that decreases hormones from both the adrenal glands and the tumor. By adding these medications to one of the androgen deprivation therapy drugs mentioned above, all androgen hormones are maximally suppressed.<\/p>\n

What other newer combinations work?<\/strong><\/p>\n

In two large clinical trials published in the New England Journal of Medicine<\/em> in 2015 (3) and The Lancet<\/em> in 2016 (4), the combination of hormone treatments, like leuprolide, when added to docetaxel (Taxotere\u00ae) chemotherapy is also very effective at improving survival in men with cancer that is widespread at diagnosis.3,4<\/sup> Chemotherapy is medication usually given through an intravenous line that kills cancer cells by damaging them so they cannot grow and divide.<\/p>\n

What approach is the right path for the \u201cbest\u201d prostate cancer treatment?<\/strong><\/p>\n

The answer is different for each patient. Trials are ongoing to try to answer this question. What is clear is the side effects and lengths of treatment are different between the two options. The best approach is decided between the doctor and the patient.<\/p>\n

References:<\/p>\n