A patient’s view on mCRPC What to tell our fellow patients! Rik Cuypers, patients association Wij Ook Belgium vzw US Too Belgium non-profit-org. Personal ideas, not necessarily reflecting the association’s point of view. Questions and remarks at any time EAU Londen 2017 – Wij ook vzw

I know nothing, I’m from Antwerp Londen EAU 2017 – Wij ook vzw

Patient’s needs Facility with the best, affordable, treatment Best doctors and nurses Quality of life priority Information Emotional support Londen EAU 2017 – Wij ook vzw

Imelda 13 september 2014 - Patiënteninspraak - Rik Cuypers Medical history of Rik Healthy life. Checked as military pilot. Sportslike Diagnosed mPC in 2001 – 58 years T3b, Gleason 8, Fracture in L5 vertebrae, Nerve compression LHRH, 30 Gy on 2 mets , Bisphosphonate 2007 PSA 7, Androgen receptor blocker 2015 PSA 154, mets in spine, ribs, lungs, liver 2015 Abiraterone, PSA < 0.1, mets ondetectable size Imelda 13 september 2014 - Patiënteninspraak - Rik Cuypers

mCRPC Metastatic when diagnosed or Recurrence after treatment of local PC or localy advanced PC Castrate resistance (questionable notion) Therapy resistance, after a testosterone reduction below 1,7 nmol/l Londen EAU 2017 – Wij ook vzw

When CR? (activity suppressed or dormant) Londen EAU 2017 – Wij ook vzw

Londen EAU 2017 – Wij ook vzw

Initial hormone treatment of mPC ADT (Androgen deprivation therapy) GnRH (agonist or antagonist) 1st line (combined with chemo on start-up) Bilateral orchiectomy (again?) 1st line Androgen receptor blocking 2nd line Londen EAU 2017 – Wij ook vzw

Advanced treatment of mCRPC Sequencing or combining; cross over. Knowledge of the cellular, biochemical, molecular, and genetic mechanisms Available treatments, FDA, EMA, country dependant Clinical trials fase III and “expanded access programs” or “compassionate use” availability Londen EAU 2017 – Wij ook vzw

Todays readily available treatment of mCRPC METASTASE Castrate resistant Hormone naive DEVELOPS INTO Not fit: ADT Fit: ADT + chemo Abiraterone Enzalutamide Solid mets: Radium 223 Chemo Sequencing, cross over, and combining Londen EAU 2017 – Wij ook vzw

Advanced treatments of mCRPC 3rd line ADT (abiraterone, enzalutamide) Chemotherapy (docetaxel, cabazitaxel) Immunotherapy (sipuleucel-T, prostvac) Immune checkpoint inhibitor activating the T-cells, (pembrolisumab) Targeted therapy PARP, DNA repair inhibitor (olaparib) Radiopharmaceuticals (radium-223 a, PSMA actinum-225 a, PSMA lutetium-177 b) External radiotherapy of oligomet Londen EAU 2017 – Wij ook vzw

Imelda 13 september 2014 - Patiënteninspraak - Rik Cuypers Adverse and toxic effects. Loss of effectiveness Often not the first priority of the doctor All treatments are palliative; work for a limited time only Emotional disturbance due to trauma and to treatment Destruction of healthy cells as well Direct effects (e.g. testosterone suppression and libido) Indirect effects (e.g. biochemical functioning of the body) Combination of treatments with same side effects Imelda 13 september 2014 - Patiënteninspraak - Rik Cuypers

Thank you for the attention! Londen EAU 2017 – Wij ook vzw