Targeted therapies, which attack specific cancer cells without harming normal cells, have the potential to treat cancers with fewer side effects than conventional therapies. Critical to the development of this approach, is to determine which treatment is most likely to be benefit an individual patient. Currently, prostate-specific antigen (PSA) is the best routinely available biomarker providing diagnostic and prognostic information about prostate cancer. PSA testing is useful, but does not reliably determine whether or not a treatment is working, nor does not provide definitive guidance in selecting one therapy over another. My colleagues and I are evaluating promising new technologies to capture and characterize circulating tumor cells from a routine blood draw. We are finding that the number of circulating tumor cells in a patient’s blood helps determine a patient’s prognosis and whether or not a treatment is working. Circulating tumor cells are also providing a biological snapshot of an individual patient’s tumor, which may help determine the choice of therapy.
As a member of the Prostate Cancer Clinical Trials Working Group, I led an international effort to standardize development of the design, conduct, and analysis of phase 2 clinical trials in prostate cancer, so we can better evaluate new therapeutics and assess their effectiveness using novel imaging modalities. The recommendations were incorporated and contributed to the successful development of zytiga (now approved) and enzalutamide (under review by the FDA). Both of these agents target androgen receptor signaling and were shown to prolong the survival of men with castration-resistant disease. I also developed the Clinical States Model of Prostate Cancer Progression, which, in categorizing the clinical spectrum of prostate cancer from diagnosis to metastasis, provides a framework to access and reassess a patient's prognosis as the disease evolves over time and to guide management of the disease.
I am also the principal investigator of the Memorial Sloan Kettering Prostate Cancer SPORE (Specialized Program on Research Excellence) sponsored by the National Cancer Institute and Principal Investigator of the Prostate Cancer Clinical Trials Consortium, a 13-center research collaborative headquartered at Memorial Sloan Kettering and funded by the Department of Defense and the Prostate Cancer Foundation. A critical part of this effort is to design and conduct clinical trials of promising new approaches so that they are available to patients as soon as possible. Since 2006, the consortium has facilitated more than 120 new early-phase studies related to prostate cancer. Ultimately, through these clinical trials, we seek to develop more-effective treatments for prostate cancers of all stages and to discover means of prevention.
In addition to serving as Chief of the Genitourinary Oncology Service for the past 16 years, I am the incumbent of the D. Wayne Calloway Chair in Urologic Oncology and a Professor of Medicine at the Weill Cornell Medical College. I am a recipient of the Donald S. Coffey-Prostate Cancer Foundation Physician-Scientist Award, and the Distinguished Alumnus Award. I also serve on numerous editorial and scientific advisory boards and am a reviewer for many journals, including The New England Journal of Medicine, Nature, Science and Translational Medicine, Lancet Oncology, and the Journal of Clinical Oncology. I have written extensively and published over 430 peer-reviewed articles in scientific journals and coauthored the textbook Principals and Practice of Genitourinary Oncology.