The Institute of Cancer Research, London, welcomes the decision by the National Institute for Health and Care Excellence (NICE) to recommend the targeted drug talazoparib (trade name Talzenna), in combination with enzalutamide, for adults with prostate cancer that has spread.
The judgement makes this new drug combination available for around 2,400 patients in England who cannot take standard treatments and for whom chemotherapy is not suitable.
The recommendation marks an important step forward in giving people more treatment options – especially those who cannot undergo chemotherapy. The once-daily pill can be taken at home, offering convenience and flexibility for patients.
The ICR's role in trialling talazoparib
Professor Johann de Bono, Regius Professor of Cancer Research at The Institute of Cancer Research (ICR) and Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, led the first-in-human talazoparib trial as well as the phase II TALAPRO-1 trial, which showed that talazoparib could kill prostate cancer cells and prevent its growth. The trial demonstrated the effectiveness and tolerability of the drug for the first time in prostate cancer.
The follow-up phase III trial, TALAPRO-2, tested the drug in combination with enzalutamide, with results providing the basis for the NICE recommendation.
Talazoparib is a PARP inhibitor – it blocks an enzyme that repairs damaged DNA in certain cancer cells. Cancer cells with DNA repair gene faults – such as BRCA, ATM or PALB2 – already have a defective DNA repair system. By using a drug to block PARP, which helps repair DNA when it is damaged, cancer cells are unable to repair themselves.
Developing PARP inhibitors
Twenty years ago, a team of ICR researchers first discovered that PARP inhibitors could be used to target BRCA-mutated cancers. Together with The Royal Marsden, researchers at the ICR including Professor Johann de Bono trialled a PARP inhibitor called olaparib in patients with breast and prostate cancer containing DNA repair gene faults.
A team of ICR researchers, led by Professor Alan Ashworth and Professor Chris Lord in the Breast Cancer Now Toby Robins Research Centre, first described talazoparib and explained how it works in 2013. Researchers at the ICR then led the first trials of the drug in humans, in 2017. The drug now joins olaparib as one of the first genetically targeted treatments for prostate cancer. As a targeted therapy, it is a much kinder option for patients than chemotherapy.
'Without the side effects of chemotherapy'
Professor Johann de Bono, Regius Professor of Cancer Research at The Institute of Cancer Research, London, and Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, said:
“There is an urgent need for effective treatment options after hormonal therapies have stopped working against advanced prostate cancer. The approval of talazoparib will provide another treatment option for these men. The pill can be taken at home, and it comes without many of the side effects of chemotherapy.
“In our TALAPRO-1 trial, we showed that talazoparib – a type of PARP inhibitor – kills prostate cancer cells and puts this into remission, especially in men whose tumours have faults in DNA repair genes such as BRCA mutations. The follow-up trial, TALAPRO-2, provided the basis of today’s decision.”