Alan H. Bryce, MD

Alan H. Bryce, MD

City of Hope

Phoenix, Arizona

Alan H. Bryce, MD, is a medical oncologist and chief clinical officer at City of Hope in Phoenix, Arizona. Dr. Bryce holds an appointment as a professor with the Department of Medical Oncology & Therapeutics Research, with City of Hope, as well as an appointment as a professor of Molecular Medicine at Translational Genomics Research Institute (TGen), which is also part of City of Hope. Prior to joining City of Hope, Dr. Bryce spent 12 years at the Mayo Clinic in Phoenix, where he served as chair of the Division of Hematology and Medical Oncology, as well as Director of the Mayo Clinic Arizona Comprehensive Cancer Center. Dr. Bryce received his medical degree from the Chicago Medical School, and then completed an internal medicine residency and a hematology and oncology fellowship at the Mayo Clinic in Rochester, Minnesota. During his time at Mayo, Dr. Bryce served as an international co-principal investigator on multiple clinical trials for prostate cancer, with his research focused on cancer genetics, novel therapies and immunotherapeutic approaches.

Disclosures:

Dr. Bryce has the following disclosures:
Consulting Fees: Astellas, Bayer, Novartis

Talks by Alan H. Bryce, MD

Perspectives in mCRPC in 2024

Alan H. Bryce, MD, reviews current research, perspectives and practices in the treatment of metastatic castration-resistant prostate cancer (mCRPC). Dr. Bryce begins with an overview of current treatment options and patterns of care and addresses the National Comprehensive Cancer Network (NCCN) Guidelines Version 4.2023 for prostate cancer.

Dr. Bryce asserts that in light of few patients receiving treatments beyond first-line, a key operational principle should be to use the best drugs as early as possible. He explains that the management of mCRPC has become increasingly complex as new treatment paradigms have developed and new drugs have been approved. He recommends thinking about classes of drugs and considering how switching or combining classes can have advantages from the perspective of disease evolution.

Dr. Bryce concludes with a brief overview of recent phase-three trial results including PSMAfore, SPLASH, and CONTACT-2. He acknowledges that after several years of continuous success, the development of new classes of drugs for prostate cancer has hit a lull but he asserts the pipeline is still full and since there is not yet a cure for prostate cancer, trials must continue.

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Updates in Advanced Prostate Cancer

Alan H. Bryce, MD, reviews the current landscape of advanced prostate cancer treatment. Dr. Bryce begins by addressing the dwindling access to second-line treatment options as patients progress through therapy lines.

He then reviews findings from the STAMPEDE study, which explored the use of combination therapy involving ADT and abiraterone for high-risk prostate cancer patients. Dr. Bryce endorses this kind of combination therapy, highlighting its effect on overall survival rates.

Finally, Dr. Bryce touches on treatment intensification for patients with MHSC-9 positivity. Using a data-driven approach, he recommends combination therapy and the potential role of triplet regimens.

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Results From TRITON3

Alan H. Bryce, MD, presents results from the TRITON3 study comparing the efficacy of a PARP inhibitor (rucaparib) against docetaxel in mCRPC treatment. Dr. Bryce reviews the study design, emphasizing the options presented to the study participants in both treatment arms. The study yielded evidence that rucaparib might be superior to docetaxel-containing treatments.

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Genetic Testing & Next Generation DNA Sequencing

Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, discusses genetic testing, next generation DNA sequencing, and the genetic diversity of prostate cancer (PCa) in regard to treatment. He begins by reviewing the germline BRCA mutations, stating that BRCA1 and BRCA2 mutations individually make up fewer than 1.3% of all cases of localized PCa. Dr. Bryce then discusses BRCA2 in detail, focusing on how BRCA2 carriers are considered high risk by the NCCN guidelines, which recommend PSA screening discussions to start at age 45. He evaluates traditional guidelines in the context of germline mutations, finding that genetic testing and Gleason score guidelines do not reliably identify PCa patients for the presence/absence of high-risk germline mutations. Dr. Bryce then discusses the mutational landscape by disease state, displaying how PCa evolves as it advances to become metastatic and castration resistant and supporting the idea that a genomic understanding of an individual’s disease is key to treatment. He reviews the approval of olaparib, a PARP inhibitor, and the PROfound trial. Dr. Bryce concludes that inherited prostate cancer risk syndromes are under-recognized, both in practice and in research, that PCa is genetically diverse, that the impact of treatments on tumor evolution should be evaluated, and that multiple new pathways for therapeutic targeting have been identified.

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Point-Counterpoint: Neoadjuvant Chemotherapy Prior to Cystectomy – Con

Taking the con side in a point-counterpoint debate, Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, argues that offering neoadjuvant chemotherapy (NAC) to patients with invasive bladder cancer prior to radical cystectomy (RC) may not always be the appropriate decision. He begins by considering what the debate even is, explaining that the NCCN considers NAC followed by radical cystectomy a category 1 recommendation based on high level data. Meanwhile, Dr. Bryce notes, adjuvant chemotherapy is only considered a category 2A recommendation. However, he continues, the NCCN guidelines also mention that patients with “hearing loss or neuropathy, poor performance status, or renal insufficiency may not be eligible for cisplatin based therapy,” and if “cisplatin based therapy cannot be given, neoadjuvant therapy is not recommended.” Dr. Bryce also argues that while clinical trial data strongly favors NAC, real-world patient populations are different from trial populations. He cites a study based on real-world data which found that the patients in the SWOG trial of NAC were younger and fitter compared with national numbers, and which found the survival benefit with NAC to be slight in retrospective data. Additionally, Dr. Bryce observes that about 33 to 41% of patients are ineligible for cisplatin due to their baseline renal function status. He notes that those patients might benefit from adjuvant chemotherapy, but acknowledges there have been few randomized controlled trials in this setting. Dr. Bryce then highlights toxicity issues related to NAC, including increased creatinine, decreased neutrophil, peripheral sensory neuropathy, and tinnitus. He concludes that because real-world patients are older and have more comorbidities than trial populations, NAC perhaps should not be used as widely as guidelines indicate.

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