Amar U. Kishan, MD
Assistant Professor, Department of Radiation Oncology
Vice-Chair of Clinical and Translational Research
Chief of the Genitourinary Oncology Service, UCLA Jonsson Comprehensive Cancer Center
Member, UCLA Institute of Urologic Oncology
Our group has three main areas of translational and clinical investigation, all with the common goal of optimizing the efficacy and safety of our treatments for men with prostate cancer.
First, we are actively investigating novel ways to deliver radiation therapy for patients with prostate cancer. These active clinical investigations range in scope from early feasibility studies to large, phase III randomized trials. Our group has a particular interest in stereotactic body radiotherapy (SBRT, also referred to as stereotactic ablative radiotherapy or SABR) for prostate cancer, which involves the delivery of high doses per day over the span of five treatments, utilizing advanced radiation delivery techniques. This form of radiation leverages the unique radiobiology of prostate cancer and is highly convenient for patients and cost-effective overall. Dr. Kishan is an internationally-recognized expert in prostate SBRT, having led a large consortium study that was the first to show long-term safety and efficacy of SBRT for prostate cancer in a multi-institutional setting and is referenced in the National Comprehensive Cancer Network guidelines for prostate cancer treatment. We are currently running three NCT-registered clinical trials investigating SBRT for prostate cancer: SCIMITAR (NCT03541850), MIRAGE (NCT04384770), and GARUDA (NCT04624256). More broadly, Dr. Kishan is the Vice Chair of Clinical and Translational Research in the Department of Radiation Oncology at UCLA and oversees the clinical research apparatus for that Department.
Second, we are performing translational studies that will help guide rational intensification and de-escalation of treatment for men with prostate cancer. While precision medicine principles are emerging at the level of screening for prostate cancer and in the setting of metastatic prostate cancer, there are very few, if any, biomarkers that can currently reliably guide decisions to increase or decrease treatment for men with localized prostate cancer. We are running several collaborative projects with colleagues in the Departments of Urology, Human Genetics, Pathology, Medical Oncology, and Statistics to help develop and validate biomarkers that can help personalize treatment decisions. This work has received extensive funding support from the Jonsson Comprehensive Cancer Center, the Specialized Program of Research Excellence (SPORE) for Prostate Cancer (via the NIH), the STOP Cancer organization, Radiological Society of North America, the Radiation Oncology Institute, the American Society for Radiation Oncology, and the Prostate Cancer Foundation (PCF). We have published preliminary work in journals such as European Urology.
Third, we are actively leveraging randomized clinical trial data and international consortium data to discover new associations and treatment principles for localized prostate cancer. While randomized trials are absolutely critical for establishing standards of care, individual randomized trials, in isolation, generally do not accrue enough patients from certain subgroups to allow meaningful interpretation of whether the trial intervention benefits that subgroup (e.g., Gleason grade group 5 prostate cancer). For these subgroups, the only ways to study them in depth are to synthesize individual patient data from multiple trials and perform a meta-analysis or study outcomes retrospectively in large, well-curated international consortium datasets. This work requires careful curation of data and sophisticated analytical techniques. We work closely with principal statisticians at the Department of Medicine Statistics Core to carry out these analyses. Multiple high-profile publications have emerged from this work, including publications in JAMA, JAMA Oncology, and European Urology, and several publications are referenced in the National Comprehensive Cancer Network guidelines for prostate cancer treatment.