In an interview with PharmaShots, Dr. Todd D. Cohen, M.D., VP Medical Affairs and Medical Director of Urology at Myriad Genetics shared his views on the ability of a biomarker test to predict which men with aggressive prostate cancer will benefit from advanced hormonal therapy and which men with lower-risk prostate cancer can safely avoid such treatments.

Shots:

• Myriad Genetics provides genetic testing that can aid in accurately diagnosing disease, determining the risk of the developing disease, assessing the risk of disease progression as well as help guide appropriate, individualized treatment options for a variety of diseases 
• It has been shown in many studies to accurately prognosticate the risk of prostate cancer-specific mortality and the development of metastatic disease when used in combination with the clinicopathologic characteristics of each patient.
• Prolaris testing is supported for all risk categories by the NCCN guidelines

Tuba: What are the key features of the oral presentation, presented by Dr. Jonathan Tward, M.D., Ph.D., of the University of Utah?

Dr. Cohen: Dr. Tward's presentation focused on the Prolaris test and how it can be used to determine which men treated with radiation for their prostate cancer would or would not benefit from intensification of treatment.  This is based on a previous study in which a Prolaris threshold was developed and validated that dichotomized men into those who would have significant benefit from intensification of treatment versus those who would see no real benefit.  This study further validated the threshold among men with contemporary radiation dosing with or without the addition of androgen deprivation therapy.

Tuba: What are the specifications of the Prolaris test and how does it help accurately predict the aggressiveness of prostate cancer?

Dr. Cohen: Prolaris is an RNA expression assay that looks at 31 cell cycle proliferation genes and 15 'housekeeper' genes. It has been shown in many studies to accurately prognosticate the risk of prostate cancer-specific mortality and the development of metastatic disease when used in combination with the clinicopathologic characteristics of each patient.

Tuba: Discuss the epidemiology of prostate cancer? Which geographical area is more prone to this lethal form of cancer?

Dr. Cohen: Prostate cancer is the second most common cancer in men in the U.S. (behind skin cancer), and about 1 in 8 men will be diagnosed during his lifetime; 1 in 41 will die of prostate cancer.  African American men have the highest incidence of prostate cancer, and they tend to develop the disease earlier in life. No one area in the country demonstrates a higher prevalence of prostate cancer than any other.

Tuba: Why is it important to predict the aggressiveness of prostate cancer in men?

Dr. Cohen: Being able to predict aggressiveness allows one to be able to help determine the appropriate degree of treatment for each individual rather than trying to treat everyone with similar clinicopathologic characteristics the same.  It is a giant step toward precision medicine.

Tuba: Can you shed some light on the updated guidelines of the National Comprehensive Cancer Network? Also, discuss the relation of these guidelines with Prolaris.

Dr. Cohen: Prolaris testing is supported for all risk categories by the NCCN guidelines.

Tuba: Discuss the working of the Prolaris test. How does it help patients, caregivers and physicians?

Dr. Cohen: The Prolaris test can be used to further risk stratify all men diagnosed with prostate cancer based on a purely molecular score in combination with clinicopathologic features.  It can be used to make and support decisions of when to treat patients and when more conservative measures such as active surveillance are a safe option. Additionally, the test can also be used in those situations where treatment is recommended to decide on the intensity of treatment.  It will clearly show which patients will benefit (or not) from more aggressive treatments and be able to provide what the absolute risk reduction would be for each man on an individual basis to determine if more aggressive treatment is worthwhile. 

Tuba: What can we expect next from Myriad Genetics in terms of new molecular diagnostic and CDx tests?

Dr. Cohen: Myriad is the only partner that can provide answers for not only how aggressive prostate cancer is, but also the patient's germline or hereditary genetic status.  This allows the treating physician to clearly understand the entire nature of a patient's disease from a genomic and genetic perspective.  Not only can Myriad testing clearly identify how a current tumor is acting, further available testing can prognosticate how the patient's cancer will likely act in the future.

Tuba: Can you briefly give the introduction of important diagnostic tools offered by Myriad Genetics?

Dr. Cohen: Myriad Genetics provides genetic testing that can aid in accurately diagnosing disease, determining the risk of developing the disease, assessing the risk of disease progression as well as help guide appropriate, individualized treatment options for a variety of diseases.  The overall goal of the work is to continue to improve every patient's care and provide the answers that each patient deserves.

Image Source: Amita Health

About Author:

Dr. Todd D. Cohen is a VP of Medical Affairs and Medical Director of Urology at Myriad Genetics. He joined the company in March 2019.

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