At the Johns Hopkins Kimmel Cancer Center in the Greater Washington, D.C., area, a key step in treating patients with prostate cancer is learning the malignancy’s genetic makeup.
“We are now sequencing every patient as the standard of care,” says Channing Paller, a medical oncologist at the Kimmel Cancer Center at Sibley Memorial Hospital and an associate professor of oncology at the Johns Hopkins University School of Medicine.
The results of that genetic sequencing allow clinicians to provide care that targets specific mutations, says Paller, whose research focuses on evaluating new therapies for prostate cancer.
These new therapies include two medications — olaparib and rucaparib — approved by the Food and Drug Administration in May for men with metastasized prostate cancer that no longer responds to hormone treatments. Studies show that both treatments reduce the size of tumors and increase longevity for men with specific mutations that prevent their cells from repairing DNA damage.
A novel approach using radiation is also available for patients with three or fewer tumors, Paller says, allowing men to delay hormone therapy, which can cause fatigue, hot flashes and erectile dysfunction.
“We used to say once patients are metastatic, they have to be treated with hormone therapy for life,” says Paller. “Now, we can often provide radiation to patients with limited metastatic tumors to delay hormonal therapy.”
At the Kimmel Cancer Center at Sibley Memorial, patients with prostate cancer receive individualized care from a multidisciplinary team that includes surgical oncologists, radiation oncologists, medical oncologists, radiologists, urologists and pathologists, says Paller.
“If you get one of us, you get all of us,” she says. “All the prostate cancer physicians who are practicing at Sibley are also practicing at The Johns Hopkins Hospital in Baltimore.”
Patients at Washington area Kimmel Cancer Center locations have access to the full range of clinical trials and treatment options offered across the Johns Hopkins Health System.
“We have 21 prostate cancer clinical trials open right now at Sibley, and many more in Baltimore,” says Paller. Those include trials for patients with rising prostate-specific antigen (PSA) levels after surgery or local radiation but with no evidence of disease in imaging, all the way to patients who have metastatic prostate cancer.
Complex and advanced cases are reviewed during weekly tumor board meetings or multidisciplinary clinics that the patient is invited to attend. “When we discuss a patient’s care at our tumor board, we come up with a comprehensive plan based on that patient, including the patient’s general health, genetic sequencing, pathology and precise imaging of tumors,” Paller says.
“We also have many imaging and biomarker clinical trials that allow patients to receive care with the most advanced technology available, years before it is approved for general use.”
Care teams for patients with prostate cancer might also include a nurse navigator, research nutritionist, social worker, physical therapist, and an expert in pain and palliative care.
“Working at a comprehensive care center is quite exciting,” says Paller. “I can offer patients more than what I know. I can offer the benefit of the entire team’s knowledge.”
