Brad Gallent, MD, PhD

Physician-scientist designing targeted therapies for prostate and other cancers to improve outcomes for our patients. Oncology Fellow @CSCancerCenter.

[Adam B. Weiner, MD @Adam_Weiner535]

🚨As early as tomorrow, congress may act on a proposal to cut DOD research funding.

This will devastate biomedical research in the US.

👇Please act now by contacting your representatives with the link below

@PCFnews @PCF_Science @CSCancerCenter @CedarsSinaiMed @UclaUrology @UCLAHealth @AmerUrological @UroOnc @UrologyTimes @urotoday @renalandurology @SFreedlandMD @AmarUKishan @uroegg @soulehoward1 @CaPsurvivorship @wandering_gu @LauraBukavinaMD @DrSpratticus @CalaisJeremie @AnthonyNguyenMD @jgong15

[ZERO Prostate Cancer @ZEROCancer]

🚨 We need your help! 🏛 This Tuesday, March 11, 2025, Congress will begin votes on a continuing resolution that includes a devastating 57% cut to the Department of Defense’s Congressionally Directed Medical Research Program. The Prostate Cancer Research Program has been instrumental in developing most of the cutting-edge treatments our community relies on today. These massive proposed cuts would severely jeopardize the future of prostate cancer research.

Make your voice heard! Contact your elected officials today, tomorrow, and Tuesday!
💻 Click the link: https://t.co/MOtCk1UKDd
📲 Text CDMRP to 1-888-824-4109

#ZEROProstateCancer #ProstateCancer #HealthcareAdvocacy #Congress

[Brad Gallent, MD, PhD @DrGallent]

@CSCancerCenter @wehodarwinian @HyungLKim @EdwinPosadasMD @SFreedlandMD @PeterChenMD @doldivizio @PCF_Science @PCFnews @soulehoward1 Thank you! Also congrats to @taylonfsilva who was also awarded a DoD Career Development Award for his work #prostatecancer.

[Brad Gallent, MD, PhD @DrGallent]

Proud to have my DoD Physician Research Award funded! So thankful to all of my mentors and collaborators, who I couldn't have done this without. @CSCancerCenter @wehodarwinian @HyungLKim @EdwinPosadasMD @SFreedlandMD @PeterChenMD @doldivizio @PCF_Science @PCFnews @soulehoward1

[The Cancer Letter @TheCancerLetter]

Cancer research fuels life-saving work, writes @CedarsSinai's Ze'ev Ronai.
https://t.co/BwlZLTxrGS

[Sumanta K. Pal, MD, FASCO @montypal]

A meeting for my #SoCal colleagues. No lengthy travel required. Join us in #NewportBeach to discuss the current status of clinical trials in our area for #kidneycancer, #bladdercancer and #prostatecancer. Keynote from @AndreaNecchi, our “external reviewer”, who will be offering insights on building collaborative research programs. Registration is free & fellows welcome to present their research in our poster session! @SoCalGUResearch @siadaneshmand @TDorffOnc @AmarUKishan https://t.co/VhLBmlm25p

[Brad Gallent, MD, PhD @DrGallent]

@jgong15 @MPishvaian @AnthonyNguyenMD Good point, in STAMPEDE (Arm H) 18% received docetaxel, as SOC evolved to include docetaxel for mCSPC as trial was accruing. I'd have to dig to see what percent of low vs high volume patients received docetaxel.

[Brad Gallent, MD, PhD @DrGallent]

13/20 #TumorBoardTuesday

📋Back to our case

65M with de novo low-volume mCSPC

Prostate RT 5500 cGy ⚡ in 20 fractions
SBRT 2000 cGy ⚡X5 fractions to T7 and L3 mets
SBRT 4000 cGy ⚡ X5 fractions to L iliac met

[Brad Gallent, MD, PhD @DrGallent]

@MPishvaian @AnthonyNguyenMD Yes, STAMPEDE (arm H) trial showed OS benefit with RT to the primary given concurrently with ADT (vs ADT alone). We tend to extrapolate and give SOC ADT + ARPI (abi/apa/etc) while treating the primary. More studies are ongoing to evaluate.

[Brad Gallent, MD, PhD @DrGallent]

Apologies, typo on the trial. Should be TITAN (with an A).

[Brad Gallent, MD, PhD @DrGallent]

20/20 #TumorBoardTuesday

Summary

Ability to detect oligomets will likely change with more use of PET-PSMA, e.g., patients with biochemical relapse but no apparent mets on conventional CT or bone scan → 74% PSMA-positive lesions

[Brad Gallent, MD, PhD @DrGallent]

Post-Test 2 #TumorBoardTuesday
TITON data for 1L apalutamide + ADT in mCSPC indicate that PSA ⬇️ ≥90% or levels ≤0.2 ng/mL in the first 3 months extend OS by:

[Brad Gallent, MD, PhD @DrGallent]

@MPishvaian Agree. Logically it makes sense treating the primary would have (more) benefit if you have less disease elsewhere. Nice when you have data to back up that gut-feeling.

[Brad Gallent, MD, PhD @DrGallent]

9/20 #TumorBoardTuesday

💡Mini tweetorial 5

📚STAMPEDE (Arm H) trial
ADT vs ADT + radiotherapy to primary
Prespecified low and high burden of disease groups
High burden: no OS difference
Low burden OS at 3 years: 73% w/o RT vs 81% w/ RT

[Brad Gallent, MD, PhD @DrGallent]

@MPishvaian Correct. The common fusion is TEMPRSS2-ERG, where ERG is the oncogene partner. There is some preclinical data supporting ERG inhibition, but none in the clinic that I know of.

[Brad Gallent, MD, PhD @DrGallent]

6/20 #TumorBoardTuesday

📋Back to our case

65M de novo low-volume mCSPC
NM bone scan, MRI, CT CAP show bone mets to L iliac, T7 spine, T3 spine 🩻
🧬NGS shows MSS, TEMPRSS2 fusion, BARD1, FGFR4
💊Bicalutamide → 💉leuprolide 22.5 mg IM Q3 months
Started apalutamide 240 mg qd

[Brad Gallent, MD, PhD @DrGallent]

Great point/question. mOS is a little deceiving to compare here since the PEACE-1 data is separated between low and high volume. When PEACE-1 low and high populations are pooled their control arms (ADT + doce) have a similar mOS: 4.4 years (PEACE-1) and 4.1 years (ARESENS). PEACE-1 pooled mOS:

[Brad Gallent, MD, PhD @DrGallent]

3/20 #TumorBoardTuesday

💡Mini tweetorial 2

2.📚ARASENS trial
ADT + doce vs ADT + doce + darolutamide
Including both low and high burden of disease
Median OS: 48.9 months w/o daro vs Not Reached w/ daro 🏆

[Brad Gallent, MD, PhD @DrGallent]

19/20 #TumorBoardTuesday

Summary

For low-volume mCSPC (mHSPC)
Benefit for local therapy to primary tumor
Benefit of metastasis-directed therapy (MDT)

[Brad Gallent, MD, PhD @DrGallent]

18/20 #TumorBoardTuesday

Summary

1L mCSPC therapies stratified by volume

High volume: Triplet therapies or ADT + ARPI (based on pt factors)
Low volume: ADT + ARPI (based on pt factors)

[Brad Gallent, MD, PhD @DrGallent]

17/20 #TumorBoardTuesday

Lack of an established biomarker to guide 1L therapies in mCSPC

🔬Studies ongoing, e.g. SPOP mutations 🧬may be predictive for ARPI + ADT

[Brad Gallent, MD, PhD @DrGallent]

16/20 #TumorBoardTuesday

Unmet needs in mCSPC

ADT intensification underutilized in real-world studies
Pts: mCSPC (2013-2018)

[Brad Gallent, MD, PhD @DrGallent]

15/20 #TumorBoardTuesday

💡Mini tweetorial 7

Sig of rapid, deep, and durable PSA declines with apa + ADT
Post-hoc analysis of 📚TITAN, median 44.0 mo

Pts: mCSPC getting ADT + apa
Achieved: >90% PSA decline or PSA <0.2 ng/ml at 3 months
Median OS: 37.7 months “Not achieved” vs Not Reached “Achieved” (HR=0.35)