Post by Allen on Jul 31, 2014 23:17:06 GMT -8
I hope that some of the doctors who use prescription drugs off-label for their advanced PC patients will comment on this series of threads.
While it may take many years to develop a new drug for advanced PC, test it, get it approved, and make it available, there are several drugs already available for other indications that may be useful as part of a cocktail with ADT, chemo and/or Provenge. I am only focusing here on prescription drugs -- I'll save over-the-counter drugs and supplements for another set of threads.
Most of our approved drugs for PC (e.g., Lupron, Firmagon, Casodex, Zytiga, Xtandi) are in some way directed against the androgen receptor (AR), which when activated, spurs PC growth. But the activated AR is not the only growth stimulant in the PC cell. There are many other growth pathways that the cancer cell activates eventually. (In some cases, it inhibits a growth suppressive pathway.) Unless the cancer cell is attacked on multiple fronts, it will always evolve a way around the attack. We don’t know if it is possible to attack on so many fronts that all cancer cells will be killed, but we do know that the sequential one-at-a-time use of medicines causes a selective pressure that the cell will eventually beat. Recently, the CHAARTED study demonstrated significant survival improvement in mCRPC when both docetaxel and ADT were started early together. There are several such combination therapies in clinical trials.
Until there are large scale randomized controlled clinical trials, we really don’t know if any of these are truly helpful or not. However, based on the established safety record of many of these substances, it may not be a big risk to add them to current standard of care treatment. The SELECT trial of Vitamin E and Selenium stands as a warning that some seemingly innocuous substances may prove to have harms.
Some of you may be interested in sending this to your oncologist as a stimulant to conversation. I’ve included a few references for each, which your doctors may find worth consideration – there are many more where they came from. They all have drug interactions, contraindications and side effects that should be carefully analyzed.
Here are the "Drug Repurposing" links for easy access:
1. metformin
2. angiogenesis inhibitors
3. somatostatin analogues
4. tyrosine kinase inhibitors
5. mTOR inhibitors
6. HDAC inhibitors
7. statins
8. SERMs
9. COX-2 inhibitors
10. De-methylators
11. Hedgehog Pathway inhibitors
12. Chloroquine
13. immunotherapies
While it may take many years to develop a new drug for advanced PC, test it, get it approved, and make it available, there are several drugs already available for other indications that may be useful as part of a cocktail with ADT, chemo and/or Provenge. I am only focusing here on prescription drugs -- I'll save over-the-counter drugs and supplements for another set of threads.
Most of our approved drugs for PC (e.g., Lupron, Firmagon, Casodex, Zytiga, Xtandi) are in some way directed against the androgen receptor (AR), which when activated, spurs PC growth. But the activated AR is not the only growth stimulant in the PC cell. There are many other growth pathways that the cancer cell activates eventually. (In some cases, it inhibits a growth suppressive pathway.) Unless the cancer cell is attacked on multiple fronts, it will always evolve a way around the attack. We don’t know if it is possible to attack on so many fronts that all cancer cells will be killed, but we do know that the sequential one-at-a-time use of medicines causes a selective pressure that the cell will eventually beat. Recently, the CHAARTED study demonstrated significant survival improvement in mCRPC when both docetaxel and ADT were started early together. There are several such combination therapies in clinical trials.
Until there are large scale randomized controlled clinical trials, we really don’t know if any of these are truly helpful or not. However, based on the established safety record of many of these substances, it may not be a big risk to add them to current standard of care treatment. The SELECT trial of Vitamin E and Selenium stands as a warning that some seemingly innocuous substances may prove to have harms.
Some of you may be interested in sending this to your oncologist as a stimulant to conversation. I’ve included a few references for each, which your doctors may find worth consideration – there are many more where they came from. They all have drug interactions, contraindications and side effects that should be carefully analyzed.
Here are the "Drug Repurposing" links for easy access:
1. metformin
2. angiogenesis inhibitors
3. somatostatin analogues
4. tyrosine kinase inhibitors
5. mTOR inhibitors
6. HDAC inhibitors
7. statins
8. SERMs
9. COX-2 inhibitors
10. De-methylators
11. Hedgehog Pathway inhibitors
12. Chloroquine
13. immunotherapies
