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Making a difference in prostate cancer

Posted on 30 July, 2013 by Henry French
Prostate cancer claims the lives of more than 10,000 UK men each year. Despite big advances in prevention, diagnosis and early treatment over the past 20 years, until recently there was a huge gap in treatment for prostate cancer once it turned resistant to hormone treatments and spread from the prostate.

Advanced prostate cancer was long treated only with palliative therapies that managed pain, but had no significant effect on how long patients lived. This gap in treatments for advanced disease was a challenge that cancer researchers simply had to meet.

It took a massive international effort to rise to the challenge, but thanks to researchers around the world – and particularly, here at The Institute of Cancer Research, London – there is something to celebrate. In the past few weeks, we’ve seen three announcements that underline how far we’ve come in the past few years in the treatment of incurable prostate cancer.

First, it was announced that a new drug called enzalutamide has been approved for use in UK patients with advanced, treatment-resistant prostate cancer. The announcement follows the publication last year of the results of an international phase III trial – led by researchers at The Institute of Cancer Research (ICR) and The Royal Marsden – which showed the benefits of the drug, which works by desensitising tumours to the hormones they use to grow.

Although enzalutamide was approved recently by the European Marketing Agency (EMA), the regulatory body that covers Europe-wide drug approvals, it’s actually been available for some time to patients in England via the Cancer Drugs Fund. The latest announcement does not mean enzalutamide is yet available more widely in the UK, but it could lead to broader use in the future.

Then, a fortnight ago, scientists from the ICR and The Royal Marsden published the results of a trial of another new prostate cancer therapy, an injection of radium 223. The phase III trial, published in the prestigious New England Journal of Medicine, showed that the radium therapy – which blasts tumours with a powerful burst of radiation – extends life in patients with advanced cancer by several months, as well as improving quality of life.

This week, we’ve seen another study led by the ICR’s Professor Johann de Bono, which shows that patients with advanced prostate cancer treated with the latest therapies are living with the disease on average for more than twice as long as a decade ago. A patient with incurable prostate cancer receiving a novel targeted therapy will live for around 41 months – just under three-and-a-half years – on average, a huge increase from an average of 13-16 months around 10 years ago.

The reason the patients from this latest study, all treated at The Royal Marsden, lived longer is thanks to new treatments: the chemotherapy drug docetaxel, first approved for use on the NHS in 2005; abiraterone, one of our biggest success stories; and a handful of experimental treatments, including enzalutamide and radium 223, which are only available in the UK by either taking part in a clinical trial or via the Cancer Drugs Fund. The study underlines the benefits to patients of signing up to take part in clinical trials – where they can have access to the latest therapies, often years before they are routinely available on the NHS, as well as the highest standards of care.

Taken together, the three new announcements still only represent the latest chapter in a long story of drug discovery and approval. Neither enzalutamide nor radium 223 will be available routinely in the UK unless they are approved by NICE in England, and corresponding approval bodies elsewhere in the UK.

There is a lot of uncertainty around the future of cancer drug approval in the UK, with a new system of ‘value-based pricing’ due to enter into force next year. There are big, long-term questions about the NHS will pay for and make available new future cancer drugs, as highlighted recently in an illuminating report from the Academy of Medical Sciences.

One of the drugs that helped men live longer with advanced cancer at The Royal Marsden, called cabazitaxel, has already been rejected by NICE.

But the latest treatments have already made a huge difference to thousands of men with incurable prostate cancer: men like John. We are still a long way from winning the war against prostate cancer, but we are making real progress.


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