Life – Terror. Ecstasy. Fight. Denial. Flight. Failure. PAIN. Forgiveness. Reconciliation. Hope. Love. Peace – Death
Research involving a new ‘search-and-destroy’ medicine known as PSMA therapy. The treatment acts like a guided missile, consisting of a radioactive particle that can be delivered directly to cancer cells.
The treatment, sometimes known as Lutetium-177 PSMA, uses a ‘homing device’ to seek out cancers by detecting the presence of a target molecule called prostate-specific membrane antigen (PSMA) on the surface of cancer cells. Once in contact, it delivers a radioactive payload to kill them.
The treatment’s PSMA target is present at higher levels on the surface of cancer cells in some patients than others, making it possible that a genetic test could pick out men who are most likely to benefit from the therapy.
A phase III trial called VISION, involving Professor Johann De Bono, showed for the first time that the therapy is effective and can keep patients with advanced prostate cancer alive and healthy for longer.
Around a third to a half of the 10,000 men a year diagnosed with advanced prostate cancer have tumours with high levels of PSMA and could therefore benefit from the treatment. For this reason, PSMA therapy, which was approved by the U.S. Food and Drug Administration (FDA) earlier this year, could be a game-changer in years to come.
Targeted drugs that are kinder to patients
Increasingly, we are moving away from a ‘one-size-fits-all’ approach to cancer care and we are getting better at tailoring treatment to individuals. However, as a cancer patient myself, I have to say I have never been offered alternative ‘personal’ treatments’? I have never encounter a consultant that has ever even discussed such treatments?
The benefit of targeted treatments is that they involve fewer side effects and can help prostate cancer patients live longer but also with a better quality of life.
In the next decade, ‘we’ are hoping to increase access to targeted treatments that already exist, bringing them to more patients, and we are also hoping to discover and develop new ones.
Abiraterone, a targeted hormone therapy discovered at the ICR and developed in partnership with our partner hospital The Royal Marsden has already given hundreds of thousands of men around the world extra years of life without the side effects of other treatments.
Another precision drug, olaparib, is known for its use in breast and ovarian cancer, but Professor Johann de Bono has led trials showing that olaparib can be effective in men with prostate cancer who have tumours with mutations in specific genes involved in DNA damage repair, such as BRCA1 and BRCA2. It is now available in Scotland as a treatment for some men with prostate cancer.
Better clinical trials with adaptive, smarter designs
Due to clinical trials new drugs eventually become available to patients?
STAMPEDE, led by Professor Nick James, is an innovative multi-arm multi-stage (MAMS) trial which also helped change the standard of care for men with advanced prostate cancer. Three of the treatments tested have shown substantially improved survival: abiraterone, docetaxel chemotherapy and prostate radiotherapy in men with disease that has spread at diagnosis.
“When we started the STAMPEDE trial back in 2005, the survival of advanced prostate cancer that had spread to other parts of the body was around three and a half years, on average. Now, it’s around seven to ten years – and abiraterone and the other advances from the STAMPEDE trial can claim a lot of the credit for that,” said Professor James
STAMPEDE is an adaptive clinical trial – meaning researchers can add in new treatments to the trial and drop ineffective treatments early. In other words, MAMS trials help us answer multiple research questions simultaneously and compare more than one treatment under a single trial protocol – saving money, time and resources, while also generating evidence more quickly and accelerating the delivery of the next game-changing treatments for patients.
The MAMS approach has famously been used to trial potential COVID-19 treatments in the RECOVERY trial, the world’s largest clinical trial into treatments for COVID-19, involving more than 40,000 participants across 185 trial sites in the UK.
“As STAMPEDE progresses, we’ve been adding new comparisons to the trial, which should help us answer even more questions, allowing us to figure out what the best way of treating men with newly diagnosed advanced prostate cancer is, faster. So far, STAMPEDE has tested ten different treatment combinations, with three more new ones in set up.”
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