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The information, views and opinions expressed in this presentation and any accompanying materials are those of the speaker and do not necessarily reflect the views or position of Cardinal Health or VitalSource.
Establishing an Advanced Prostate Cancer Clinic: The Rationale
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Conference Objectives • Discuss key steps and insights into establishing an
advanced prostate cancer clinic and gain insight into the clinical and operational considerations for managing the treatment of prostate cancer in the urology setting.
• Provide information on the practical management of patients on CRPC therapies.
• Learn about the evolving healthcare landscape changes and how to navigate access/affordability.
• Provide guidance on how community urology practices can effectively partner with other healthcare providers.
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Prostate Cancer 2015
220,800 new cases expected 27,540 deaths expected
1 man in 7 will be diagnosed with prostate cancer during his
lifetime. The average age at the time of diagnosis is about 66.
2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.
http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics
Prostate cancer is the second leading cause of cancer death in American men
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Before 2010, The Last Agent Approved for The Treatment mCRPC was Docetaxel
LHRH agonists Reversible AR blockers
1984-1989
Mitoxantrone 1996
Zoledronic Acid 2002
Docetaxel 2004
Abiraterone (post-chemo)
2011 Abiraterone (pre-chemo)
2012
Radium-223 Enzalutamide (post-chemo)
2013 Enzalutamide (pre-
chemo) 2014
Cabazitaxel Sipuleucel-T
2010
Denosumab 2011
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What is the optimal place for docetaxel in treatment of
metastatic prostate cancer?
Local therapy
Androgen deprivation therapy (ADT)
Therapies after ADT
Death
ADT
mCRPC post-
docetaxel
mCRPC symptomatic
mCRPC mildly
symptomatic
mCRPC
asymptomatic
(failed ADT)
Hormone sensitive
Docetaxel
Moving indication? ADT + Docetaxel
in high-volume
disease?
Around 40% of patients do not respond to first-line docetaxel
Median overall survival of docetaxel + prednisone is ≤ 2 years
Tannock et al. N Eng J Med 2004; 351(15):1502
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Treatment Landscape
Androgen Deprivation
Chemotherapy
Postchemotherapy
Death Local Therapy
Sipuleucel-T
Therapies After GnRH Analogs
and Antiandrogens
Chen Y, et al. Lancet Oncol. 2009;10:981-991. Hofland J, et al. Cancer Res. 2010;70:1256-1264.
Docetaxel Cabazitaxel
Surgery/ Radiation
Standard Androgen Deprivation Therapy
Denosumab, Zoledronic Acid
Radium -223
Enzalutamide
Abiraterone
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Summary
• Therapeutic options for advanced PCa patients now
allow for improved patient-physician shared decision
making.
• Specialization and commitment to the treatment and
management landscape is essential.
• Ongoing and future trials will serve to better inform our
current unmet needs and questions.
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Summary
• Urologists are playing a greater role in the care of
patients with mCRPC.
• With this comes the responsibility of keeping up with the
advancements and self-education around existing and
emerging therapies.
• Monitoring for both disease progression and AEs is an
important aspect of caring for these patients.
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Summary • Urologists are in a unique position to offer extended care for patients
with mCRPC.
• Understanding the basics of assessing disease extent as well as the
patient's needs is important to offering the right care.
• The AUA guidelines are driven by knowing the rate of progression
and characteristics of the metastatic disease, whether the patient is
symptomatic, the patient's overall performance status, and whether
the patient has received docetaxel in the past.
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Summary
• Five new therapies have become available that improve
survival in patients with mCRPC.
• Each has a unique mode of action and strategy to
reduce tumor burden.
• The administration, dosing, cautions, and adverse
events are important for urologists to know in order to
determine which therapy is right for the individual patient.
The information, views and opinions expressed in this presentation and any accompanying materials are those of the speaker and do not necessarily reflect the views or position of Cardinal Health or VitalSource.
A GUIDE TO ESTABLISHING AN ADVANCED PROSTATE CANCER CLINIC
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Objective
• Discuss key insights into establishing an advanced
prostate cancer clinic (APCC)
• Discuss key insights into the integration component for
managing the treatment of prostate cancer in the urology
setting:
o Clinical integration
o Operational integration
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Background
Rising Healthcare costs Aging population expansion
Shifting sites of care
The demographic, clinical, and economic pressures are influencing the healthcare system
Longer time on treatment
Maximizes Value Proposition Quality of care +
Efficient delivery of care
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Shifting Paradigm: Volume → Value
• The healthcare landscape is changing rapidly
• Along with this change begets opportunities for forward thinkers to enhance their urology practice, and
• Also understand the importance of collaboration and sub-specialization
Expanding specialty clinic is an opportunity:
Advanced Prostate Cancer Clinic (APCC)
Advanced OAB center
E/D center
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Why Develop APCC?
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Advanced Prostate Cancer Clinic (APCC) Dedicated Champions Physician Champion
Nurse Champion Administrative Champion
Clinical and Business Integration
Collaboration and Sub-specialization
Success for patients and the urology
practice
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