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Bloomberg Brief | healthcare Finance 12 Q & A Dr. cy stein sees a role for zytiga, Jevtana and enzalutamide in Prostate cancer Q: have you faced any issues with re- enzalutamide in the first-line setting? cy stein, M.D., Ph.D., an oncologist special- imbursement? how has J&J marketed a: It could be better than Casodex but
izing in the biology and treatment of genitouri-
nary cancers, discussed recent developments
a: Some patients are not covered for Zytiga.
in prostate cancer with Elizabeth Krutoholow.
J&J has done a brilliant job marketing the
Q: if enzalutamide proves effective as
The subtle differences between Johnson &
drug. It’s very easy to communicate its ben-
a front-line therapy and has an over-
Johnson’s Zytiga and Medivation’s enzalu-tamide could create a marketing battle.
efits scientifically and they have gone all out. all survival benefit in its label, would this encourage use over Zytiga if it Q: if Medivation’s enzalutamide is only is labeled for a progression-free Q: What is your standard approach for approved, how will it fit into the treat- survival benefit? treating metastatic castrate resistant ment paradigm with Zytiga, Provenge a: The overall survival data for enzalu- prostate cancer? and Jevtana? a: There is no standard approach and a: Enzalutamide is another good drug.
Phase III trial in the front-line setting did
I am waiting for the published data on it.
have two primary endpoints and it only hit
How will it fit with Zytiga? If a patient has
one-progression free survival. Zytiga did
not reach overall survival but this data is
Q: how would you describe your expe-
However, it won’t be a question of either
received afterwards anyway. Also, in the
rience with Provenge?
or with these drugs and patients will be
a: I have used Provenge in the hospital
given what they can tolerate. The fact that
sion free survival since I am just trying to
setting, so I have not had any issues with
Zytiga must be given with steroids while
put off giving taxotere so overall survival
reimbursement and I select patients that
enzalutamide does not is not a major sell-
will not be turned down. There is a fear
ing point for Medivation. Prednisone is not
FDA will approve it for first-line use with-
a rough drug. Jevtana is also a very good
out overall survival remains unclear.
drug and I have seen fantastic results with
it. It tends to be more toxic and Sanofi did
Q: What other experimental therapies
not market it as well as J&J has marketed
are you most interested in?
months in two Phase III trials but it does
Zytiga. Also, many think that Jevtana is
a: aragon Pharmaceuticals’ ARN-509 is
just another taxane but it really is different.
vival and we cannot assess how a patient
me-too drug. takeda’s TAK-700 looks
is doing. If there is new objective disease, I
Q: since Zytiga and enzalutamide have
then treat with ketoconazole which is a ge-
different mechanisms of action, could
Zytiga. There is also galeterone from tokai
neric drug that is similar to Zytiga and very
the two be combined? Pharmaceuticals, which is a small com-
inexpensive. It is more toxic than Zytiga,
a: The combination may be cost-pro-
pany in Cambridge. This is very similar to
but provides about a 50 percent response
hibitive but it would be great to combine
Zytiga but they have had positive Phase I/
II results. None of the drugs we have so far
dose to alleviate some of the toxicity. Also,
are a homerun as they only help about 50
Zytiga is not yet approved for use before
percent of patients and all provide incre-
taxotere. Once patients fail on taxotere,
mental benefits. These are elderly patients
then we look toward new medications.
though so any benefit is a good thing. Still, some patients do really well and having
Q: What is your experience with John- Q: What are your expectations for son & Johnson’s Zytiga? a: Zytiga is a good drug. It is pretty non- toxic with some mineralocorticoid side effects. The response rates with Zytiga Role: Chair of the Department of Medical Oncology & Therapeutics
depend on whether or not a patient has had prior treatment with ketoconazole. Re-
Research, City of Hope comprehensive cancer center, Duarte, CA
sponse rates are lowered in patients who
Awards: Named top physician in his field by New York Times Magazine
have taken it because the drugs have a similar mechanism. I won’t deny a patient
ketoconazole for this reason though since
Summer Plans: Spending time in New York with his first granddaughter
I am trying to stretch a patient for as long
who was born 8 weeks premature and is doing very well
Publikationen Prof. Dr. med. Sven Waßmann Endtmann, C., Ebrahimian, T., Czech, T., Arfa, O., Laufs, U., Fritz, M., Wassmann, K., Werner, N., Petoumenos, V., Nickenig, G., & Wassmann, S. 2011. Angiotensin II impairs endothelial progenitor cell number and function in vitro and in vivo: implications for vascular regeneration. Hypertension , 58(3): 394-403. Zimmer, S., Steinmetz, M