ASCO International Perspective | experience hot flushes and night sweats (HFNS), which not only decrease their quality of life but may also affect compliance with ADT. Current relief methods are limited. At the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, Professor Simon J. Crabb from the University Hospital Southampton presented the results of the MANCAN2 study. "Oncology Frontier" invited Professor Simon J. Crabb to share his thoughts on managing prostate cancer.1. Managing ADT-Related Adverse Reactions
Oncology Frontier: Androgen deprivation therapy (ADT) is the standard treatment for localized, recurrent, and metastatic prostate cancer, but it can also cause adverse reactions for patients. Based on your clinical experience, please share how to manage these adverse reactions?
Dr. Simon J. Crabb: Certainly. About half of prostate cancer patients will receive androgen deprivation therapy at some point during their treatment. Additionally, many patients will also receive an AR-targeted agent alongside ADT. While these therapies are effective, they come with a range of potential side effects, including fatigue, hot flushes, night sweats, metabolic issues, bone health problems, and cardiovascular events.
We start with a comprehensive discussion with the patient about the potential side effects. We have found great success in utilizing prostate cancer nurse specialists who work with patients to develop coping strategies for these side effects. A key area we focus on is bone health. Every patient undergoes a DEXA scan at the start of treatment to assess bone health. We provide calcium and vitamin D supplementation and determine the need for bisphosphonates based on the DEXA scan results. Addressing cardiovascular health is crucial. We ensure that conditions like hypertension are well controlled and manage other cardiac risk factors. This comprehensive approach helps mitigate the cardiovascular risks associated with ADT.
2. Role of CBT in Managing ADT-Related HFNS
Oncology Frontier: Current treatment emphasizes patient-centeredness, and you have also conducted the relevant MANCAN2 study. So what role can CBT play in the management of ADT-related hot flushes and night sweats?
Dr. Simon J. Crabb: Hot flushes and night sweats affect about 80% of patients on ADT and can significantly impact their quality of life. These symptoms can also lead to depression, anxiety, and cognitive issues, and sometimes affect the patients’ willingness to continue their therapy. While pharmacological approaches exist to manage these symptoms, they are not always ideal. We have been exploring non-pharmacological approaches, such as cognitive behavioural therapy (CBT), which has shown promise in reducing the frequency and impact of hot flushes and night sweats.
3. Future Research to Improve Quality of Life for Prostate Cancer Patients
Oncology Frontier: What research will you conduct in the future to further improve the quality of life of prostate cancer patients?
Dr. Simon J. Crabb: At ASCO 2024, we presented data from the MANCAN2 study, a randomized trial where prostate cancer patients on ADT with hot flushes were assigned to receive either standard care or CBT. We found that CBT significantly reduced the impact of hot flushes at early time points, up to six weeks. However, these effects were not sustained at six months. This suggests a need for longer intervention durations and possibly booster sessions to maintain the benefits of CBT. Interestingly, CBT was also associated with better compliance with ADT, which is an important area for future development.
Simon J. Crabb, MD, Professor
- University Hospital Southampton
- Research interests include bladder cancer, prostate cancer, predictive biomarkers, and more.
Professor Crabb is a Professor of Experimental Cancer Therapeutics at the Cancer Sciences Academic Unit and an Honorary Consultant in Medical Oncology at the University Hospital Southampton NHS Foundation Trust. His research focuses on novel cancer therapies, including precision medicine approaches for bladder and prostate cancer, mechanisms of cancer treatment resistance, and epigenetic therapies. He is the Deputy Clinical Director of the Southampton Clinical Trials Unit and Clinical Lead for the Southampton Experimental Cancer Medicine Centre.
Professor Crabb also serves as the Chair of the Clinical Interpretation Partnership for Bladder Cancer at Genomics England, a member of the NCRI Bladder and Kidney Group, NCRI Prostate Group, and the Experimental Medicine Expert Review Panel at Cancer Research UK.
