Prof Nick James

Joseph Ischia: I’m Talking Urology with Nick James. He’s a clinical oncologist from Birmingham and the lead investigator for STAMPEDE and he’s come all the way to Melbourne to give us some fantastic talks about STAMPEDE and what it means for us. So, the two talks were the role of postop radiotherapy in non-metastatic patients, high risk non-metastatic patients, and also you’re second talk was STAMPEDE moving AR-targeted therapy earlier. Nick what were the key points you want us to take away from your talks?

Prof. Nick James: So, the key point from the first talk is that it’s pretty nailed down that’s for men with high risk non-metastatic node-negative disease you should give radiotherapy on top. So, the contentious areas are what to do with node-positive patients? So, one of the things we’ve been able to look at in STAMPEDE because some patients with node-positive disease did have radiotherapy, some didn’t is do a comparison. It looks as if the ones who had radiotherapy for node positive disease have roughly half the relapse rate of the patients who just had hormone therapy alone. So, we published General Oncology last year that’s a point I’m keen to pursue because I think these patients have, I think they’re often undertreated especially with modern radiotherapy care, so you could deliver dose safely to pelvic nodes.

Joseph: Excellent! And the STAMPEDE moving AR-targeted therapy earlier?

Nick: So, again this is, obviously I’m getting in a lot of airmiles talking about this topic and so it’s clearly there has been a sea change in prostate cancer. So having, from 1940s through to the late 2010, there was no change in the upfront management of men starting hormone therapy for prostate cancer apart from the introduction of radiotherapy for the high risk non-metastatic so it was literally the only change in 70 years and all of a sudden we’ve had two positive trials with docetaxel with the STAMPEDE and CHAARTED data and now we have the same situation on abiraterone, and my hunch will be the little turnover but actually you’d probably get dual benefit from both but we’ve got to wait for that data. So it’s a very exciting time. We’re seeing you know big survival games off the upfront use of life-prolonging therapies literally for the first time since the 1940s.

Joseph: Wonderful! Thank you very much Nick. It’s been an absolute pleasure having you here in Melbourne.

Nick: Yeah, no it’s been fantastic. No, thank you.