HJR 20 - PROSTATE CANCER DRUGS CHAIR WILSON announced that the next order of business would be HOUSE JOINT RESOLUTION NO. 20, Urging the United States Congress and the United States Food and Drug Administration to assist in the prompt approval of new drug applications for the treatment of prostate cancer. 4:01:03 PM REPRESENTATIVE CARL GATTO, Alaska State Legislature, sponsor of HJR 20, stated that as a survivor [of prostate cancer] he sponsored this resolution because of the complete absence of drugs available. He said he is interested in the management and identification of cancer, and commented that there are few, if any, drugs used in the treatment of prostate cancer. He mentioned that there are certain drugs that are being studied that could aid in treating prostate cancer, and this legislation may serve to encourage the federal government to make more drugs available [for prostate cancer patients]. He offered his understanding that 5 people a day in Alaska contract cancer, and that 25 people die every year from prostate cancer. 4:04:13 PM REPRESENTATIVE GARDNER noted that the sponsor statement appears to have a discrepancy. REPRESENTATIVE GATTO relayed that he'd meant the sponsor statement to indicate that this year, the expectation is that 5 people will die every day from cancer, and that 25 of those people will die specifically from prostate cancer. REPRESENTATIVE GARDNER commented that according to her understanding, if men live long enough, most will develop prostate cancer. REPRESENTATIVE GATTO concurred, and said that when autopsies are performed on victims of car accidents, all the men are found to have [prostate cancer]. He made mention of various methods of treatment currently available. CHAIR WILSON commented that she was shocked to read the "Whereas" clause on page 1, lines 13-14, which claims that $16.9 billion in productivity is lost every year due to prostate cancer. 4:06:29 PM DALE SNELSON, Chapter Leader, Us TOO Mat-Su Valley; Regional Director, Us TOO International, Inc., first related the story of his discovery of having developed prostate cancer and opting to have his prostate removed. He said: We don't really have the drugs to fight it. ... It's a deadly disease, it's the most solid tumor that the human body can conceive. ... About 75 percent of it is very slow moving. For ... example, [for men] 65 years old, ... 65 percent of the men will have [prostate cancer] ... but not die from it. [For men] 80 years old, 82 percent will have and not die from it. But then on the flip [side], we have the 20 percent, and I'm in that 20 percent group. If I would have not [had a] prostatectomy a year ago March, I would have been gone - dead - by now. ... Worldwide, research and development on prostate cancer is just going like wildfire. ... Prostate cancer is a silent killer ..., and it's amazing how many men don't even know what a prostate is - it is very, very deadly. ... If you catch it early ..., they can do a lot of things and you will live. ... Alaskans [are] really hard to penetrate as far as [spreading awareness of] ... prostate cancer, and ... [so] we're really working on awareness programs now; we are going to start soliciting our blue magnetic ribbon - ... when people see those they'll say, "prostate." ... MR. SNELSON commented on the reluctance of a man to go to the doctor, and on how it often ends up being his wife that insists he visit the doctor. He detailed some of the history of Us TOO International, Inc., and Alaska's chapters. 4:11:15 PM MARK MOYAD, M.D., Director, Phillip Jenkins Endowment, University of Michigan, said that he thinks he has a unique relationship with the people in Alaska because he recently visited Juneau and spoke at the Men's Health Fair, and has gone to Anchorage each year for almost the last ten years in a row and spoken before [Anchorage's] "prostate group." During the past year, he relayed, one of the leaders of the prostate group, a man in his early fifties, passed away from prostate cancer. Dr. Moyad went on to say that the main problem currently is a lack of access to promising treatments. He relayed that he'd promised the aforementioned gentleman's widow that he would get involved in the process of trying to educate men with regard to what is likely to be an issue for them and to how they should be giving serious consideration to the issue of prostate cancer. DR. MOYAD noted that although the "early access program" - or "compassionate use program" - is available in cases involving breast cancer or colorectal cancer, it is not available in cases involving prostate cancer. He said "we" would love it if people around the world could have access to new targeted therapies, therapies that could potentially help advanced patients while having a low rate of side effects. He made mention of one promising drug for which the biggest side effects appears to be a runny nose or headache. Unfortunately, younger prostate cancer patients are also affected by not having access to targeted therapies, and although prostate cancer has developed the reputation of having more people die with it than from it, the problem with that line of thinking is that it belittles the facts that it is the second leading cause of cancer death in men, that about 28,000 to 30,000 men still continue to die from prostate cancer in this country alone, and that a lot of those men are younger. DR. MOYAD reiterated that getting access to promising treatments is a real problem, adding that he doesn't know of any other cancer that has more of a problem with regard to accessing treatment. CHAIR WILSON asked why the rate [of prostate cancer] is increasing. DR. MOYAD surmised that age, race, lifestyle, and genetics increase the risk factors significantly. He noted that if one looks at countries that have low rates of prostate cancer, when people from those counties move to the United States, within one generation they experience the same increasing levels of risk as Americans. And while a lot of people have used that statistic to say that the increased risk is due to the American environment, the American diet, and the American lifestyle, he also thinks that part of the problem can be traced back to a genetic factor, particularly since it's not unusual to see prostate cancer in two or three generations of a family. 4:17:33 PM DR. MOYAD, in response to the question of why he thinks early access programs or compassionate use programs are not available for prostate cancer drugs, surmised that it could in part be due to the fact that there hasn't yet been a large-scale, passionate movement to address the issues and educate people about the issues associated with this type of cancer, whereas there have been such efforts made regarding breast cancer, colorectal cancer, and cancers associated with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). He said he sees that state of affair changing, though, and relayed that Betty Ford once told him: "I do believe in my heart that ... when I was diagnosed with breast cancer in the early '70s, there was no real movement and there were no real educational materials, and ... look what's happened in 30 years. ... I know you get frustrated with prostate cancer sometimes but I think you'll see that change." DR. MOYAD said he now sees more support groups, more people getting involved politically, and more people getting involved in asking for more research dollars, though it's been a slow transition and there is still a great deal more to be accomplished scientifically as well as politically. 4:20:35 PM DR. MOYAD, in response to further comments and questions, pointed out that there are many similarities between breast and prostate cancers in terms of genetics and treatment; for example, primary treatment for both cancers involve hormone therapy. He suggested that one difference in drug development for the two types of cancers might be that the average age for the diagnosis of prostate cancer has been a few years higher than for breast cancer, and there is already an awareness that breast cancer can be a younger person's disease. He added that he is excited by the fact that the development of breast cancer drugs will aid the development of prostate cancer drugs. MR. SNELSON concurred with Dr. Moyad's comments, added that more and more young men - men in their 30s and 40s - are falling victim to prostate cancer, and emphasized the need for early detection of prostate cancer. 4:25:23 PM REPRESENTATIVE GATTO asked Dr. Moyad to comment on two new drug therapies that he's recently become aware of - "Xinlay" and "Provenge." DR. MOYAD said that Provenge is a vaccine and is given three times as an injection. He opined that the benefits [of Provenge] outweigh the risks and that it may be the first vaccine that could actually allow cancer patients to live longer. He said that as new drugs are developed to help patients with more advanced stages of the disease, one of the questions that arises is what would happen if some of the more benign treatments were tried early on - would doing such result in avoiding harsher treatments or perhaps even in preventing the disease to begin with? He went on to mention some of the possible side effects of [Provenge and Xinlay] treatment. He spoke of his frustration regarding the amount of time it is taking for HJR 20 to move through the process, but also expressed his belief that the resolution is doing a lot to raise awareness of the issue of prostate cancer and its treatments. 4:27:39 PM REPRESENTATIVE ANDERSON moved to report HJR 20 out of committee with individual recommendations and the accompanying fiscal note. There being no objection, HJR 20 was reported from the House Health, Education and Social Services Standing Committee.