In an interview with PharmaShots, Todd Cohen, MD, Vice President of Medical Affairs/Medical Director of Urology at Myriad Genetics shares his views on the precision medicine and prognostic tests for Prostate Cancer

Shots:

• The company reported the importance of precision medicine and prognostic tests that can help to determine cancer & enables personalized treatment paths. The company highlights the ability of genetic testing to provide clearer treatment
• The study published in the International Journal of Radiation Oncology showed that the Myriad Genetics Prolaris test can be used to identify treatment benefits in men with prostate cancer
• The study concluded that incorporating genetic risk data from a tumor analysis helps the patient’s risk score more accurate and individualized compared using the standard clinical and pathological factors alone

Tuba: How can precision medicine improve the quality of life of patients living with Prostate Cancer? 

Todd Cohen: With prostate cancer, there are several treatment paths. Clinical tests such as Gleason score and prostate-specific antigen serve as standard measurements for prostate cancer risk assessment but are not very good indicators of exactly how aggressive the prostate cancer is, nor are they good at prognosticating outcomes such as cancer-specific death or metastasis.  

Precision medicine and prognostic tests can help better determine the true nature of the patient’s cancer to create the most appropriate personalized treatment paths for men based on how their tumor is behaving. Genetic testing can help more men and their doctors to better understand prostate cancer aggressiveness and enable them to make more personalized treatment decisions.  

Tuba: Discuss the year 2021 in prostate cancer and the precision medicine developments we will likely see in 2022? 

Todd Cohen: Our understanding and knowledge of hereditary mutations in prostate cancer continue to grow. This will not only help men with their treatment plans, but it will also help identify family members that may be at risk not only for the cancers that are detected in the patient but many other cancers as well. 

In 2022, I envision an increase in our knowledge around hereditary and tumor-specific mutations and the understanding of the diseases they cause. We will likely continue to see growth in treatments that are specifically designed for people who have certain genetic changes and are much more likely to respond well. I anticipate we’ll also continue to see the adoption of genetic testing increase as part of care and treatment plans. 

Tuba: What are the key takeaways of the study published in the International Journal of Radiation Oncology? 

Todd Cohen: The key takeaway from the study showed that the Myriad Genetics Prolaris test can be used to accurately identify which men with prostate cancer would benefit from more aggressive treatment, and which men can safely avoid it or have minimal benefit from intensification of treatment.  

Without genetic testing, men with prostate cancer have their risk of metastasis and cancer progression scored with a variety of clinical and pathological factors. In this study, we evaluated genetic testing for 741 men with prostate cancer categorized as NCCN intermediate, high, or very high risk. The men had been treated with radiation; many had received ADT in addition. The original tumor samples from all men were assessed with the Prolaris genetic test, which uses the presence of specific genes within a tumor to determine how aggressive the cancer is and what level of treatment may be recommended.

The research found that adding Prolaris risk data significantly improved the ability to identify which men would benefit from hormone therapy and which men wouldn’t. For example, men with certain lower-risk Prolaris scores had a likelihood of just 3.7 percent that their cancer would metastasize in the next 10 years. That group of men can safely and confidently skip hormone therapy, avoiding the potential side effects of more aggressive treatment.

Tuba: Were there any unforeseen findings from the study? 

Todd Cohen: I’d say one finding that was not necessarily unforeseen, but important to see, was how many higher-risk patients didn’t have significant benefit from adding ADT. While many studies have shown the overall improvement in outcomes by adding ADT in this population as a whole, the Prolaris test can now be used to specifically identify on an individual basis who will benefit.

Tuba: What are your upcoming plans in this area? Are you planning to conduct more studies on prostate cancer? 

Todd Cohen: We will absolutely look to do more studies on prostate cancer as we look the deepen our knowledge to better help men and their doctors treat the disease. One area that we’d like to explore more is ADT duration to better understand and identify the best timing for treatment and how much treatment to give each individual patient to optimize treatment.  

Tuba: What are the clinical inferences of the study? 

Todd Cohen: As mentioned above in question #3, the study showed that Prolaris can accurately identify which men with prostate cancer would benefit from more aggressive treatment, and which men can safely avoid it. 

In the study, we concluded that incorporating genetic risk data from a tumor analysis made each patient’s risk score more accurate and individualized compared to using the standard clinical and pathological factors alone. 

Tuba: What do you think about the future of prostate cancer treatment? 

Todd Cohen: Individualized treatment plans for each prostate cancer patient. We want every patient and doctor to have all the information they can. We’re hopeful that through our continued research and studies we’ll be able to identify the exact cause of the disease and have treatment specific to that cause. There is still so much work to be done, but we’re making great strides. This study represents another step forward in precision medicine and offers a clearer path for clinical decision-making for this group of patients, their families, and their physicians. 

Source: MedicineNet

About Author:

Dr. Todd Cohen is the Vice President of Medical Affairs/Medical Director of Urology at Myriad Genetics. Dr. Todd Cohen obtained his AB with Honors in Chemistry from Dartmouth College and then studied medicine at the University of Rochester where he gained his MD. He continued his education with a Fellowship in Endourology and Minimally Invasive Surgery at Duke University

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