Image: A colour-enhanced image showing a clump of prostate cancer cells. Credit: Annie Cavanagh, Wellcome Collection, CC BY-NC 4.0
This week is Men’s Health Week, an important time to raise awareness of male cancers. Prostate cancer has become the most common cancer in the UK – with almost 50,000 men being diagnosed every year. At the ICR, our scientists carry out an extensive amount of world-class research aimed at tackling the disease.
Our research initiatives have delivered genetic discoveries, precision radiotherapy regimens and diagnostic blood tests. But arguably, one of our greatest achievements is the discovery and development of abiraterone – a targeted treatment used in men with prostate cancer that has spread to other parts of their body.
Most of the initial research and clinical development of abiraterone was carried out at the ICR and involved Professor Mike Jarman (now retired), Professor Ian Judson, Dr Florence Raynaud and Professor Johann de Bono, among others. Their work, which also included later-stage international clinical trials, eventually led to abiraterone’s wide regulatory approval in 2012.
How STAMPEDE changed the standard-of-care
The FDA, EMA and NICE approvals of abiraterone enabled many men with advanced disease, who had stopped responding to standard hormone therapy, to benefit from the targeted drug.
However, Professor Nick James, who recently joined the ICR from the University of Birmingham as a new Team Leader in Prostate and Bladder Cancer, set out to test a new approach that looked at using abiraterone at an earlier stage – at diagnosis, instead of waiting for other standard hormone therapies to stop working. This was part of the so-called STAMPEDE clinical trial.
“Abiraterone works by blocking the production of the male sex hormone testosterone, which can fuel prostate cancer and enable it to grow and spread. It blocks testosterone in a different way to standard hormone therapy, and initially, abiraterone was only given to men who had stopped responding to standard hormone therapies. However, we wondered if outcomes could be improved even further for men living with prostate cancer,” he said.
Professor James found that combining abiraterone with hormone therapy from the get go could result in a longer and better quality life for these patients.
“I’m really proud of the positive results delivered by STAMPEDE, which have helped change the standard of care for men with advanced prostate cancer. When we started the STAMPEDE trial, the survival of metastatic prostate cancer, on average, was around three and a half years. Now, it’s around seven to ten years – and abiraterone and the STAMPEDE trial can claim a lot of the credit for that.”
“As STAMPEDE progresses, we’ve been answering questions, but we’ve also added new comparisons to the trial. Around 12,000 patients have been enrolled in the study – and we’ve just added two new comparisons, which should help us answer even more questions.”
Our wide-ranging programme of prostate cancer research at the ICR has delivered new targeted cancer drugs, radiotherapy regimens, genetic discoveries and diagnostic blood tests. Together these have had huge benefits for patients – helping men to live longer, improving their quality of life and increasing cure rates.
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The potential of abiraterone
Earlier this year, abiraterone became available to men with advanced prostate cancer as first-line treatment, when given alongside hormone therapy, on the NHS in Scotland.
Recently, NHS England also approved the use of abiraterone during the COVID-19 pandemic as a first-line NHS treatment for men with advanced prostate cancer – although its use is currently limited to patients who are unable to take enzalutamide.
Professor James was one of the researchers who wrote to NHS England and the Cancer Drugs Fund urging them to widen earlier access to abiraterone for men across the UK during the pandemic.
He has welcomed the decision in the hope that more men can benefit from the drug as soon as possible. One of the advantages of abiraterone, particularly relevant in the midst of the COVID-19 crisis, is that it is a pill that can be taken at home – requiring less face-to-face hospital time and therefore reducing the risk of infection and easing the pressure on NHS resources.
Abiraterone also has different side effects to chemotherapy, which is known to weaken the immune system and can cause lung complications. This means that abiraterone could potentially be a safer option for prostate cancer patients receiving chemotherapy, who are in the at-risk group for COVID-19.
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Next steps and future collaborations
Apart from running large-scale clinical trials that could improve the lives of people with cancer, Professor James actively collaborates with laboratory groups to understand the underlying mechanisms at play in these trials.
“My work doesn’t involve running a lab, but I do interact and collaborate with laboratory groups to understand why treatments work. We know that no drug works for every patient, so figuring out who does respond to treatments, who doesn’t, and understanding why helps us tailor therapies and find alternative options for those who need them.”
“The STAMPEDE trial, which aims to assess new treatment approaches for people affected by high-risk prostate cancer, definitely remains one of my biggest projects – and I’m working to build new collaborative research initiatives around it.”
Professor James is now planning to start research collaborations with scientists at the ICR, including Professor Bissan Al-Lazikani, who focuses on multidisciplinary computational techniques for clinical application. Together, they would like to figure out new ways of integrating AI into the interpretation of complex trial data.
Professor James is also hoping to work with Professor Alan Melcher and Professor Kevin Harrington, who lead research focused on oncolytic viruses and immunotherapy for the treatment of cancer. By working with them, he hopes to improve our understanding of the immune environment in prostate and bladder cancer, which could potentially lead to new ways of treating these cancers.
“Working collaboratively is something that I really value. The concentration of world-class experts at the ICR is unbelievable – and being able to design new research collaborations with these experts is great.”
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