Understanding the role of biomarkers in PCa treatment
29 Oct 2015 - Joel Vega
With the current emphasis on providing personalised treatment to prostate cancer patients, expectations on the role of biomarkers may have been too high and experts say delivering optimal management requires understanding the usefulness of biomarkers within the context of a robust multidisciplinary treatment plan.
“It is interesting to lament that there are no high-quality biomarkers in prostate cancer. Compared to other malignancies prostate cancer has quite a set of powerful biomarkers, along with PSA, and we have seen in most recent years the advent of a number of new biomarkers including imaging that have the potential to change some of our management strategies,” said Prof. Karim Touijer (USA) of the Memorial Sloan Kettering Cancer Center in New York.
Touijer is co-chairing with Dr. Riccardo Valdagni and Prof. Hein Van Poppel (BE), EAU Adjunct Secretary General for Education, the European School of Oncology (ESO) Interdisciplinary Conference “Personalized approach to prostate cancer management” in Barcelona, Spain on 12 November. The ESO Conference precedes the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC) and aims to complement the EMUC, an annual gathering of medical oncologists, urologists, radiation oncologists and pathologists who specialise in onco-urological malignancies.
Touijer pointed out the benefits of biomarkers in PCa management should be taken within the context of collaborative therapy.
“It must be said that a biomarker is only robust if used in the appropriate context. Utilizing a biomarker outside of its intended context of use is incorrect and may diminish its performance,” he cautioned.
Biomarker research and development is a time-consuming, protracted process which requires extensive funding and, ultimately, this translates to high costs when it finally reaches practical use in the clinical setting
Touijer, however, looks at the flip-side of the biomarker story and says the use of biomarker technology delivers more gains and eventually tips the balance against the initial drawback of high financial costs.
“While novel biomarkers, in general, might contribute to rising cost in the initial phase, they have the theoretical potential of reducing cancer care related costs on the long-term by reducing disease-associated morbidity and mortality,” he said. “And their impact might be even greater when used in the preventive context. Access to healthcare inequality already exists and represents a serious problem that ought to be curbed at the health-policy maker level.”
In Barcelona, Touijer would be speaking on the current paradigm shifts in prostate cancer treatment and will provide a comprehensive overview on how the major developments in the last few years should prompt cancer experts to exercise more flexibility and incorporate in actual practice recent gains made in genetic research and drug development.
“To highlight the tremendous advances in the last 10 years, one can cite following: the immense work on the value of prostate screening, the determination of active surveillance as a valuable management option to reduce overtreatment, and the introduction of genomic- based tools to provide insights on disease aggressiveness and aid in clinical decision-making,” he said.
Among others, he also enumerated advances such as the development of MR imaging and the launching of the promising molecular imaging field, technical improvements in the delivery of surgery and radiation therapies, the breakthrough understanding of the complex biology of the androgen receptor, and the discovery of several life-prolonging drugs with distinct mechanisms of action.
He underscored that achieving progress in such a short time (within a decade) has prompted existing models of treatment to change just as knowledge does, and which means it is no longer “business as usual” for cancer specialists.
“The old format where various specialties that treat prostate cancer operate independently through the various clinical state models is no longer valid,” Touijer said.
“To answer the pressing questions today, urologists, medical oncologists, radiation oncologists, radiologists and pathologists need to work together with the patient to determine the best sequence and combination of treatment in order to maximize oncological outcomes and quality of life preservation,” he added.