Dr. Maneesh Jain:
I'm Dr. Maneesh Jain. I am a physician at the Washington DC VA Medical Center, and I have an associate professor title at George Washington University. And both Mr. Llobet and his wife have been seeing me now for a little over two years and they see other physicians and academic centers in the area and they were just coming to me for an additional opinion in case we had any sort of novel treatment options or if there was anything that we could provide any sort of insight into Mr. Llobet's care. And our research team were very fortunate and appreciative that the Prostate Cancer Foundation in 2019 gave us our initial grant as a PopCap Center of Excellence grant and we were one of the original sites chosen. The money was distributed between us and George Washington University. And I think that that work is what led us to having a concept approved where we were looking at immunohistochemistry markers in advanced prostate cancer patients.
Rudolfo Llobet:
My journey to meet Dr. Jain ... First of all, my wife Kelly is here because she really runs the show behind the scenes. No, she has an outstanding memory. She can absorb technical materials. She did a lot of research for diet and just all the things you don't think about when you get a cancer diagnosis right off the bat. So she was on it. But anyway, so I'm a more typical military person in that I did a small amount of years. I did almost eight years in the military then as a pilot. I flew in the Navy. I got out and then I went to the airlines. People that aren't pilots, a lot of them, they put a little bit of time in, then they come out, but they're veterans. And as a pilot, I was blessed with a good occupation, so I had good insurance and all that.
But my friends that were still active duty, believe it or not, are the ones that encouraged me to get a primary care physician at the VA, which because of my diagnosis eventually led me to Dr. Jain down in DC as pathologist for what ailed me for the prostate cancer. So it was my friends because, for some reason, they knew more about all the benefits and opportunities that could come from being in the VA healthcare system. So I thank them, all the individuals and collectively. But anyway, my particular diagnosis was in 2019 and it did not register as a PSA marker. It registered as hip pain. And having been a runner, I thought, "Oh, whoa is me. I'm going to have to get a hip replacement or something." And I was flying and pulling my little bag along with the wheels, which should be pretty easy to do, and it was hurting and it just kept getting worse and worse every flight.
So finally, I think February 15th ... I may have said February 16th somewhere in the past, but February 15th was my last flight from London to Washington DC and then decided I need to go see the doc and see what's going on with me. And eventually we got to an MRI with an orthopedic gentleman, which led to them identifying some metastasis, possible pentastasis in the left hip. And it was all left oriented. So the diagnosis came shortly thereafter in April, technically, and then I started down the path with my local insurance and all that, and I think I finally got into the VA healthcare system in ... That was in 2019, the diagnosis, so I think in 2020 or 2021, somewhere in there, and then shortly thereafter to Dr. Jain. So we've been seeing him almost three years or ... About that. About three years. Maybe just shy.
So that's the big picture of the path. And along the way, I've tried several trials through these other institutions, non VA, and then this opportunity came with Dr. Jain for what we're doing now. That's the short story. What's interesting is PSA testing under the insurance system is once a year. Well, when I did my annual physical, it was one day shy of a year, so I couldn't do it. We have five children and they were smaller then. By the time I rescheduled everything, it was 17 months since my previous PSA. And my previous one was nothing. It was negligible. It was 0.8 or 0.08. It was just something ridiculously low. So in that time, it had flowered and spread and done all sorts of things. So more often testing would've been a nice thing in my particular case. And what's interesting, they found that pilots tend to get more aggressive forms of prostate cancer than the general population.
Dr. Ramesh Subrahmanyam:
Hi. I'm Ramesh Subrahmanyam. I manage the hematology oncology research program here in Washington DC VA Medical Center. I've been working with Dr. Jain and the oncology program here since around 2019, 2020. That's around the time when the Prostate Cancer Foundation and the VA established the Center of Excellence for Prostate Cancer here at the DC VA Medical Center in George Washington University. The primary goal of the Center of Excellence was to make sure that all of our veterans with metastatic prostate cancer, they get next-gen sequencing, genetic testing, and based on the results of genetic testing, whether they would be eligible for targeted therapies or not. That pathway is now standard of care throughout the VA. All the prostate cancer patients with metastatic prostate cancer end up getting next-gen sequencing as standard of care at the VA. The second thing that we are very thankful to Prostate Cancer Foundation for is to support our proposal for a research study to look at biomarkers of relevance, whether it is predictive, therapeutic or prognostic markers in prostate cancer.
We started doing this using biopsy tissues and doing immunohistochemistry. That's an assay that shows us what markers are expressed on the cell surface. So Prostate Cancer Foundation supported us to do this particular project and while we were doing this project was when results from a clinical trial using a HER2 directed antibody drug conjugate came up. Dr. Jain can go into the details of that result. But because we had this biomarker project already going on, for us, it was a very easy step to see, hey, maybe it's time to look at HER2 expression in prostate cancer. I should say that this has been done before. Almost 15, 20 years ago, or even longer before that, people had looked at HER2 expression in prostate cancer and people had tested HER2 directed therapies in prostate cancer 15, 20 years ago. None of them worked.
It was a total failure and for the last 15 years, nobody again looked at HER2 in prostate cancer from the perspective of therapeutic approaches. The difference between the previous approaches and the current approach is that the drug that we are using is not directed towards the HER2 signaling pathway. There's a difference. When you are targeting HER2 signaling, you just block the signals that are coming from the HER2 protein into the cell and blocking off that signal stops the cell from growing and leads the cancer cell to die. That did not work in prostate cancer before. But the new approach is using something that would recognize the cells based on whether they express HER2 or not, but then delivering a chemotherapy agent to those cells. So it's not blocking the signals coming through HER2. It's just recognizing the cell that expresses HER2, but then the chemotherapy agent goes and kills the cell.
So nobody knew whether this would work in prostate cancer or not, and we thought this would be a good idea to test it. And we are in the process of starting a clinical trial, but the trial is not open yet for enrollment. Mr. Llobet needed the clinical trial in February. So instead of waiting for the trial to open, we decided to give the therapy to Mr. Llobet off-label with complete approval from our pharmacy and the management and oncology here and it seems to have worked really well. We are really happy about it. Dr. Jain will obviously go into the clinical responses that Mr. Llobet had, but from the support that we had from PCF for the biomarker project, how we looked at the expression of HER2 in prostate cancer and how that helped us determine whether this would be a good therapeutic agent or not in prostate cancer, that's the way the progression happened in our center that eventually led to Mr. Llobet getting this therapy.
Dr. Maneesh Jain:
To provide a little bit of background, we had, as Dr. Subrahmanyam had mentioned that we were looking at biomarkers of interest in advanced prostate cancer patients. Immunohistochemistry is not routinely done in prostate cancer and some of the stuff on HER2 had been done, but the paper that we cited or looked back at was an AACR paper in 2010. And in that paper they mentioned that in prostate cancer there is this low level of HER2 expression. The drugs, as mentioned before, like Herceptin and lapatinib did not work. But maybe in the future if there is a more novel treatment approach, that could be something that we could consider. When this data was presented in breast cancer in 2022, it was at the ASCO conference. It was a plenary session and there were these women that had low levels of HER2 expression and they tried this trastuzumab deruxtecan and had an amazing response.
The person who presented got a standing ovation and it really changed the game in breast cancer. There is an email on that night between me and the research team saying, "Hey, should we kind of re-look at HER2 expression in prostate cancer?" Some of the members of my team still have that email saved and have it in bold because that's really where the journey started. We have a poster that came out in ASCO 2023 where both George Washington University and our VA have a majority African-American population. And we had a poster where we were just looking at the prevalence of HER2 using a little bit of a different scoring system. The scoring system that was traditionally used is the breast scoring system or the gastric scoring system. We came up with our own modified gastric system or GI system based on the morphology of the HER2 expression in prostate cancer.
So that was what was put into a poster, which led to discussions with the pharmaceutical company, which led to where we are today. When Mr. Llobet came and saw me, and I think he can provide further clarity, he was running out of options and him and his wife have been ... They're excellent in communication. They will call me, they'll write emails. I almost feel like we're somewhat like a close family in the sense that I call them every week. I literally call them every week just to see how they're doing. So they were just mentioning that, "Hey, we have this chemotherapy option that was mentioned at an outside center, but is there something else to consider?" And we had gotten his primary prostate and the disease in his neck. We got his prostate or the tissue here, and we saw that based on our scoring system, his HER2 was three plus. And I told Mr. Llobet that, "I'm not sure if this is going to work. We don't have any sort of published data that this drug has been a tried in prostate cancer, but we see that your expression is high. I think it's worth a shot." And they agreed and here we are.
Dr. Ramesh Subrahmanyam:
Dr. Jain used the term HER2 three plus. What that scoring means basically is how high a level of expression of HER2 does the tissue have. That's one way scientists and clinicians look at the expression level of surface markers. One plus, two plus, three plus are the scores that are given. And as Dr. Jain mentioned, typically for HER2, people look at the scoring system established for breast or for GI cancers. The difference with prostate cancer is that prostate does not express HER2 at the same level as the other cancers. So if you want to find a three plus in prostate, it's going to be almost impossible because overall, prostate always expresses low levels of HER2. So can we use these other systems? It becomes relevant because the drug that we are talking about, trastuzumab deruxtecan, it's approved by FDA for use in solid tumors that have three plus expression of HER2.
So even though it could in theory be used for prostate cancer, using the GI and breast scoring system, you would never find a prostate cancer patient having a three plus. That's the reason why we published that paper where we took into account the overall low level of expression of HER2 in prostate cancer, and then we modified the GI scoring system so that we could get the same range, zero, one, two, three plus in prostate. Using our scoring system, that's where Mr. Llobet's tissue turned out to be HER2 three plus. And the results I think are quite evident based on the treatment that he's been getting.
Dr. Maneesh Jain:
So Mr. Llobet had ... And he will clarify or go through his journey, so I will definitely let him go through all the steps that happened. But he has treatment emergent neuroendocrine cancer. So what that means is that prostate cancer over time and after undergoing androgen deprivation therapy and multiple lines of therapy, it can change its morphology or pathology to a more aggressive type. And so the prognosis once you become this neuroendocrine differentiation is most patients die within a year. And his disease is extremely aggressive, which he will walk through the journey where it was involving his neck and his brain and he had surgery in October and then a few months later it came right back. So I just want to highlight that his subtype was this neuroendocrine differentiation and is extremely aggressive.
Rudolfo Llobet:
We'd been seeing Dr. Jain, and then when he was able to release a little bit more information, he'd let us know that I might be eligible for this and he explained the expression without revealing more information that they were allowed to because it was still young, this whole process. But it was very encouraging because I'd gone through a lot of trials. I think I've done four trials and-
Kelly Llobet:
Nine treatments.
Rudolfo Llobet:
Nine treatments. One of the trials was pretty established, so we knew it was not a big deal, but a couple ... Yeah. So several treatments. The latest one was wearing me out from the side effects, fatigue, nausea and things like that. So they temporarily pulled me off on that. And that's about the timing when I started on the off-label with Dr. Jain. It was very encouraging. There was a great initial response. And like Dr. Jain said, he included all the technical data that I don't understand. So a bunch of elephants came into my room in the form of a brain metastasis and so we had to use other interventions for that to level the time playing field because the brain metastasis would've overridden everything if it was left to grow.
And I'd like to think that the treatment that Dr. Jain is providing at least kept it from growing as fast maybe. I'll believe that if it doesn't hurt anything really. But so far, here I am. There's no super solution to this, but without a doubt, I feel fine. Just the general fatigue that comes with five plus years of treatments and response to disease, side effects from the disease and the treatments combined. But I think they've done some great work here and it's very encouraging. And if it all fails tomorrow, I've gotten this far. I didn't think I was going to get to age 60, but-
Kelly Llobet:
Yeah. I'm going to step in here and back us up on the timeline a little bit. So in 2019 when Rudolfo was diagnosed, the very next day, my father was diagnosed with leukemia. So this was a bang, bang on the family.
Rudolfo Llobet:
Yeah, it was.
Kelly Llobet:
And it came as a crushing blow from all different directions. So we were diagnosed in April and our 20th wedding anniversary was coming up on April 10th, and that's what we did for our 20th wedding anniversary was we started on a hormone deprivation clinical trial. That was our celebration for the 20th wedding anniversary. We never thought we would get to our 25th because when Rudolfo was diagnosed, it was aggressive off the charts. It was Gleason eight and nine from the get-go. It was already out. And they said we need to really live as much life as we can in a short period of time. So we started off on a clinical trial. We immediately went to radiation that had been shown to be successful through Stampede. We did chemotherapy, docetaxel. We did a series of other clinical trials, and we were bouncing from treatment to clinical trial throughout these five and a half years.
We've been on nine different treatments and over half of them have been clinical trials. And now this one with Dr. Jain, thank God, is even preclinical trials. So we've been on this ride on a really fast ride since the beginning. But as you can see, speaking with both of these doctors, you can hear them teach when they talk, and there's humility in both of them, which I think is key because I remember the first time we met Dr. Jain and we talked about our children, we talked about his children, and it wasn't just I'm in this for me. He wants to solve problems for his patients. And we've been blessed to have those kind of doctors and a couple other institutions that are also supported by PCF, which is really cool that they've woven through this journey since the beginning for us. And so we could tell from the beginning. Rudolfo said to me ... I remember getting in the car on the way home, and he said, "I like that guy." And I thought, "Yeah, we need to come back and visit him." And so that's when we were like, we need to keep this relationship because there's something very special. He wants to solve problems, he wants to help people. And so that's why we came back to Dr. Jain. And so when we got to a place in ... Let's see. The first skull metastasis was in 2023.
Rudolfo Llobet:
End of 2022, 2023, they treated it.
Kelly Llobet:
And they treated it with some radiation and it started growing within just a few months. And so by October of '23, he was in a nine and a half hour brain surgery, having that tumor removed. Then had follow-up radiation. That was in December that we had that follow-up radiation. In January of '24, Rudolfo landed again in the hospital for two weeks because he was having symptoms. We've been through all of these treatments with all of these lovely doctors and Dr. Jain all along the way had been going, "I think we've got something. I think we're going to open a trial soon." And I got on the phone with Dr. Jain because our lovely oncologist from another teaching institution came into the room, and everybody loves Rudolfo. And he came in, I could tell he was really affected by this, and he said, "Our backs are against the wall, Kelly. Our backs are against the wall."
And they were offering basically a kind of chemotherapy that I think was sort of going to be a swan song. I think hospice might've even been in the discussion coming up. There was that kind of thing. And I was driving back in to see him and Dr. Jain returned my phone call and we were right by Camden Yards in Baltimore when the phone rang and Dr. Jain said, "How soon can you get down here? We need to do this." And so we got Rudolfo stabilized, and that was the last ... I think it was January 30th, January 31st. So we were set up to come see Dr. Jain. When we got Rudolfo out of the hospital that January 30, 31st, I came home and there was a letter in the mailbox. And we homeschool our children and the base where the school is based out in the northwest.
And they said, "We're going to have a graduation ceremony in June." And so I'm just getting this man out of the hospital, not knowing what we're looking at and I'm thinking, "I don't know if that's what we're going to be doing in June." But we had at that point, a senior in high school and one graduating out of eighth grade. And so I thought, I don't know. So I took that letter and I put it behind a little religious statue that I have, and I thought, "You're going to take care of this, my statue, and we're going to give this to Dr. Jain and see what he's got."
And I forgot about it because I thought ... I didn't tell Rudolfo because being an airline pilot, he wants to travel everywhere all the time. But I also didn't want to disappoint him or whatever. So we started the therapy on ... We started Enhertu in February, February 22nd, and we had really good response pretty immediately. And so we were okay. So I get an email that says, "Do you want to RSVP for coming out to the northwest? It's coming up." And this was in early May. And so I'm looking at him and I'm looking at the email and I'm looking at him, and I thought, "We might be able to do this." So I went over and I got that letter that I put in there that day after and took it out and I handed it to Rudolfo and I said, "What do you think? Do you think we might want to go do this?"
And he looked at me like I was crazy. And then he thought, "Yeah. Let's go do this." So it worked out that this graduation ceremony landed right in between the three-week cycle of the therapy of this in Enhertu therapy. So we RSVPed, we took all four of our sons, we rented a vehicle, and we drove around the northwest for two weeks and saw God's country out there. It's gorgeous. And we stopped and had the graduation ceremony and came back just in time to get some blood work and get right back on Enhertu.
And we even sent Dr. Jain pictures and all the researchers that you all fund, all the researchers got to see that ... We started the first therapy on our 20th wedding anniversary. In April this year, we celebrated 25 years of marriage. This one, we didn't think we were going to get to his 60th birthday. This August, he celebrated 60, which we didn't think we were going to get to. And so it's those kind of things that have made that little bit of difference in our lives. And our sons. They're 22, 20, 18, and 14, and they will never forget this trip. I know we won't. But that's something that really sticks with you. And if it weren't for PCF stepping up and these two gentlemen and the other institutions, then we wouldn't be sitting here with you and having made these milestones and done these really neat things.
Rudolfo Llobet:
And the Prostate Cancer Foundation has been floating around in our household for a while because Kelly has been forwarding stuff from the Prostate Cancer Foundation since my diagnosis. I am not lying. It's been a good source of information and debunking bad ideas. Because what does a patient do? They get a diagnosis and where they go? Dr. Google. Dr. Google is a bad doctor. He doesn't have a degree. Why did I look there? You'll be dead in a year. Don't worry about it. It's like, no, I don't want to hear that.
Kelly Llobet:
And there was so much support through-
Rudolfo Llobet:
Absolutely.
Kelly Llobet:
PCF. The nutrition information alone. And my degree was in nutrition, so I could read it and I thought, "These guys are legit. They're not just spouting what they think. This is some legit information, what they're putting out on PCF." And in the meantime, it was kind of funny because being in the Baltimore area, my dad was big in baseball, and I know Cal Ripken Jr. partnered with the PCF Foundation back right around in 2020. My dad was friends with him. So having the PCF floating around and just being a part of our world in the background, not even knowing is pretty incredible. And what you all did for us, we can never thank you enough. We're grateful. Eternally grateful.
Rudolfo Llobet:
Absolutely. We're actually still under the oversight of one of the doctors that is covered by my primary insurance, Blue Cross Blue Shield. And I know Dr. Jain actually converses with him on a regular basis. Actually, this is also novel in the amount of coordination that we have doctors doing stuff for me, which I feel extremely humbled. But there's a lot of benefit to that because problems arise that one will find that others don't and then everybody knows. Everyone gets on the same sheet of music. So it's been very profitable to have them talking to each other, not just for me, but for their own research, I'm sure.
Kelly Llobet:
Well, and it's a testimony to the kind of people that they are. And I know from having conversations with the doctors and the nurses that we see that they go into this for reasons that are personal to them. A lot of them have had cancer touch their families when they were young. And so they've come back to help people who have cancer or are suffering in some way. So they're doing this for those reasons. But I know that Dr. Jain knows some of the other doctors that we have seen because of some of the interaction through PCF conventions or meetings and such. So it's not as though they're unknown to each other. They've collaborated on different things in the past. So they're all interested in helping Rudolfo, their patients. And so we are truly fortunate, undeservingly so, that these men and women who are working together have been able to do these kinds of things and they just do it. They just do it because they want to help.
Rudolfo Llobet:
And I noticed the VA, they've been funded a little bit better than the last few years, thank goodness, and it increases the access for those that are underserved. I know the African-American community in the DC area, Baltimore area area as well. But it's not just isolated to them too because ... And pilots are some of the worst offenders. Hey, don't test me because if you find something, then it's there. If you don't test me, then I don't have anything, right? I don't want to be sick. I'm eight foot tall and bulletproof. I'm a pilot.
Kelly Llobet:
And an ostrich apparently.
Rudolfo Llobet:
But it's true. Pilots are so ... They're stubborn. Oh my goodness.
Kelly Llobet:
That's true.
Rudolfo Llobet:
And I'm like the least stubborn of the pilots I know. But it's true and people need to know that the Prostate Cancer Foundation and the VA has a lot of resources, and they don't make you feel like you're intruding. They actually give a lot of access, which is wonderful. It's essential.
Dr. Maneesh Jain:
I just want to echo the thoughts here. I mean, I think that the Prostate Cancer Foundation has given the support and created this PCF-VA partnership. And this right here just highlights the collaboration that was started a few years ago. And I do feel like I do connect with the physicians who work at other hospitals in the area. They have appointments at other VAs and large academic centers, and Mr. Llobet's care requires sometimes a lot of coordination between all the different centers. I have all the emails and cell phone numbers of those other physicians so that I'm able to reach out to them to come up with a coordinated plan so that when I'm talking to the Llobet family, I can say that this is the plan of care based on this. Mr. Llobet gives a lot of hope. He had this treatment emergent near endocrine cancer. He had failed multiple lines of therapy. His prior lines before this had only worked three, four months. Now we're nine months in, and he's still doing so well.
It's kind of incredible to me because the doctors at the other centers say, "We're so impressed with how he's doing." Recently he had one brain lesion that got resected and he's about to undergo radiation. And I don't think that those doctors would've offered those options if he hadn't been doing well everywhere else. So that really highlights the strength of trastuzumab deruxtecan in his case. And with that, I hope that ... This recently got published in the Annals of Internal Medicine. I hope that our clinical trial will start in a short order. It's a multi-VA site trial, and with seven VA sites and then George Washington University. We want to test varying people with HER2 expression and see how well do they respond. And I hope that this case report motivates people that there are treatment approaches that I would ... Although HER2 has been looked at, I'm going to call this novel in the sense that this is a new antibody drug conjugate that really came out in the last few years, and there's no other antibody drug conjugate approved in prostate cancer.
So my hope is that we have an upcoming trial that this encourages other physicians to think of the VA and PCF as a resource for newer treatment options, and that all advanced prostate cancer patients get tested for this immunohistochemistry for HER2. And I will add one more thing. And one thing that I think sometimes people will miss is in prostate cancer, the HER2 is not seen by typical next generation sequencing. So Dr. Subrahmanyam mentioned that that is what we do. That is the standard of care. But HER2 is rarely seen as an amplification or a mutation. So if you're not going to check it by this immunohistochemistry, you're going to miss it. And so you have to check it. You should check it in advanced prostate cancer. If you're not going to have the right scoring system, then you might not be giving people like him this benefit because he would've been scored as a lower score, so he would not have been candidate for this pan tumor approval.
So there's a lot of messages that I think I'm trying to suggest. Partnership with VA-PCF testing the tumor for HER2, what is the right scoring system, not relying just on next generation sequencing. And he gives us so much hope. He was the perfect patient because whatever I said or whatever I would do ... Recently, glorious on the call, we wanted to do also ... Just have a photo and a conversation from the VA side. And I called them on Wednesday night and I didn't even give them that much advance notice and they were like, "Yeah, sure. We'll come by tomorrow to the VA and we're happy to help." Even for today. "Yeah, of course. You want to set this time. We're here." So I really appreciate that from both of them. They always have this kind of curiosity and they always feel like they're open to things and they're very easygoing. And so I will always in my heart appreciate the relationship that I have with them.
Rudolfo Llobet:
I can't thank the Prostate Cancer Foundation enough for just stitching everything together, so to speak. And thank Dr. Jain, Ramesh and all the other doctors that obviously have contributed and helped me get to this path. A lot of innovative things going on here. The antigen drug conjugate. Things that are coming into the regular vocabulary of advanced prostate cancer is wonderful. I think I also bring a unique perspective as a pilot because there's an awareness among the pilot community that we seem to get a higher rate of cancer from military flying. It's interesting, there's a couple of studies out there from the Air Force that show that if you were a military pilot versus a civilian pilot, the civilian pilot has the same cancer rate between the age of 50 and 60 as the general population. Whereas if you had military time, for prostate cancer, it's I think 13% plus depending on some circumstances. So the enhanced testing that Dr. Jain has brought into the picture here for targeted therapies ... Which by the way, I can't say enough because the targeted therapy, the bottom line is I don't have a lot of side effects that I would've if I were just getting chemotherapy. And that's a huge difference. I mean, I basically deal with fatigue and muscle strength, which I've been dealing with. So it's nothing new, but there's nothing beyond that, which is a miracle in and of itself, I think.
Kelly Llobet:
Like Dr. Jain said, Rudolfo is an ideal patient. He's also an ideal patient to be the caregiver for. He's patient and he's humble. He's open to all these things. He's made it easy for me. But all of us have become really a team, and there's a trust portion and there's an intellectual portion. And putting Dr. Jain and Dr. Subrahmanyam together with that, not only are they good men that you can talk to, but they're also ready to teach you what they're going to do so you can trust in what's going to happen. So that's really important, so being involved and listening and understanding what's going on and listening to what the doctors are teaching is really important as a caregiver because then I can anticipate what his symptoms might be, what he's going to feel. I know that he's going to feel more fatigued one day, he's going to have some nausea this day. Little different things along the way.
But building a relationship with the doctors, with the technicians, with the nurses, with every single person, because they all come to work at those hospitals because they want to help people too. And they're human beings. They want to talk to you. They want to know how things are going. Christmas, Thanksgiving, everything that's going on. They want to know about the family. They want to know what I'm crocheting. You build a relationship with all these people, and if you have that relationship, they're looking out for you because you're looking out for them. And all of that, being totally involved. As much as possible, get yourself educated. Read the stuff that comes out from the emails that come out from the Prostate Cancer Foundation. Look things up on the NIH.
See what's out there. Go to clinicaltrials.gov. Look those things up. Find out what can be done for your loved one. Because doctors want to want to help, you want to help, so we're all in this together. And that attitude, that approach, and then of course, it goes without saying, a faith community is absolutely key. Because you need all of that support to keep us coming through the door going, "What do you got for me, doc? What are we going to do?" But if you're holed up in a corner, you're not talking to anybody, then that's not possible.
Rudolfo Llobet:
And just to wrap it up, I think for me personally, I always thought that this would be a scary trip. But the scariest part is the diagnosis. Once you understand the diagnosis and that scare pinnacle has come and gone, do what Kelly said. Get educated. Prostate Cancer Foundation is a great resource, I think. Go to your doctors, ask the questions. There's resources out there. Don't be afraid. Be not afraid to go ask questions and find out what your resources are because you might be missing out on something. Don't ignore it. It's not going to go away. It's there. And I think that's very important. The resources are out there. The VA has really gone leaps and bounds in providing these resources. You don't feel like a number. It used to be different. I know not from personal experience, but from what I've heard, read and complaints and all that. So go out there, be bold. Be bold. It's not a fight, it's a coordination. It really is coordinating your quality of life. I don't go, okay, yeah, it's three to five years. I don't have a calendar on there. I just walk in for infusion and say hi to the docs.
Kelly Llobet:
And Teresa.
Rudolfo Llobet:
And Teresa, the nurse. And she runs the joint. But the resources are out there. Ask the questions. Don't be afraid because you might miss out on something. Really. There's a plethora of things out there for us. There's all sorts of choices to be made and a lot of people to help us make those choices.
Kelly Llobet:
There's a lot of love out there.
Rudolfo Llobet:
There is.
Kelly Llobet:
Just got to let it happen.
Rudolfo Llobet:
Yep.
Dr. Ramesh Subrahmanyam:
I think Dr. Jain summarized most of the clinical progression as well as where we see this going. There was one thing that I wanted to add. I don't have a background on prostate cancer. My research was all in leukemia and then blood cell development for my post-doc. Until about four years ago, I knew nothing about prostate cancer and then Dr. Jain educated me too regarding when we talk to patients, what happens, what are the different stages of the disease, how does it progress, what are the different treatment options that are out there. So I learned a lot in the process. And one of the things that I have learned is that there aren't a lot of targeted therapies in prostate cancer. The NGS that we had talked about can identify a couple of pathways, mismatch permutations, high tumor burden, mutation burden or homologous recombination, repair pathways.
These are all targeted towards specific mutations that probably correspond to maybe 20% of the patients. So a majority of the patients don't really have anything that can be targeted. Our hope is that HER2 we have seen could be expressed in almost half the patients at the advanced stages. So maybe what would work, what could be an additional option, targeted therapy option, is this antibody drug conjugate targeting HER2. Personally, even if it helps 10% of the patients, I would be satisfied. We don't know how many patients are going to benefit from it until we run the clinical trial. But even if you increase it by 2%, 5%, 10%, I would take it. So we really need those extra options of targeted therapies in prostate cancer. Hopefully the clinical trial and Mr. Llobet's case that we have seen in the past eight, nine months, those are going to help advance the field further.
Kelly Llobet:
You keep listening to these two men talk about how it works and how the drug works and all those kinds of things. And so part of I keep saying education and all that is that they teach us and then while Papa was in the hospital, I could come home. They made it so that I could understand, consumable for me, and then I brought it home to our sons and sat around the kitchen table while Papa was still in the hospital and drew pictures. "This is what Ramesh and Dr. Jain are telling me are going to happen with this medication. What do you guys think?" And we talked about it. So being able to help the children also understand at their level helped to ... It helps to make for a more stable patient also, because they're not wondering what's happening with Papa. They feel a part of it too. So it's not just me, it's the whole crew behind us that we can come home and take what they're teaching us and then teach them too.