mCRPC in focus
Transcript: What guideline recommendations are challenging to apply in clinical practice?
Professor Karim Fizazi
All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
Well, I guess to improve outcomes for all the patients, well first of course we have to follow guidelines. We have to be aware of guidelines.
We have to follow them. And limitations include probably lack of knowledge. For example, here in the U.S., surveys indicate that many patients still do not receive treatment intensifications for metastatic castration disease, which is really a shame. ADT alone is still being used quite broadly. And I think it's mostly a question of knowledge.
Many doctors just don't know the recent data supporting strong benefit for this man when intensification is being used. Another limitation is availability or reimbursement of these agents, or cost. Also, when people are paying out of pocket or when insurances decide not to cover. So I think those are important limitations. Toxicity is actually, to be honest, less of an issue, less of a limitation. I think we've been able to mitigate most of the toxic effects we're seeing. Of course not perfect. We still need to do all the homework, but you know, for example, if I take Abiraterone, it's not that difficult to manage, to monitor hypertension/hypokalemia and transamidase increase. With Enzalutamide, you need sometimes to dose reduce due to cognitive impairments, especially in the elderly. And some other drugs are quite well-tolerated. Darolutamide is is an example.
It's very well-tolerated, in general. So again, toxicity is mostly not a major issue. It's really more knowledge and availability at least in some countries, or cost when people are paying out of pockets. Supply sometime is a limitation. This is the case for Lutetium PSMA in countries where it's either approved or accessible. We have difficulties getting it at the moment just because of short supplies. Hopefully, this will be fixed from now to the summer. But this is something that's happening often with radioisotopes, in general, in oncology. And of course when a patient needs those treatments, waiting for six months is hard to swallow, to be honest. So those are the limitations I mostly see for the practise. And I may add also sometimes that the systems are sometimes too slow to approve and reimburse agents that have shown activity. And this is also something all the countries should work around.
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