“This innovative form of targeted therapy promises to change the treatments now considered standard because it offers a cure for those prostate cancer patients who already have metastases and who no longer benefit from the treatments available.” Thus Lori J. Pierce, president of the American Society of Clinical Oncology (Asco), comments on one of the studies considered most relevant presented during the annual congress of the American association of oncology, which opens today in a virtual version. The results of the studio VISION, which involved 831 patients with progressive metastatic prostate cancer resistant to castration (ie resistant to treatment with hormone therapy), are in fact exposed during the plenary session of the conference, the main one: “Men treated with 177Lu-PSMA-617, a new targeted therapy with radioligand, in addition to the best standard of care achieved a 38% reduction in the risk of death (with an average overall survival benefit of 4 months) and a 60% reduction in the risk of disease progression compared to the only therapy currently considered standard “he clarifies Giuseppe Procopio, Head of Genitourinary Medical Oncology of the IRCCS National Cancer Institute of Milan.
The most frequent cancer among Italian males
With about 36 thousand new cases diagnosed in 2020 in Italy, prostate cancer is the most frequent cancer among Italian males. Fortunately, 90 percent of patients are still alive 10 years after diagnosis: an important milestone, especially considering that it is a form of cancer typical of old age and that most of the patients are over 70 years old. Despite therapeutic advances, however, in a high percentage of cases the disease evolves into a form resistant to therapy and metastasizes. When the neoplasm reaches an advanced stage, in 90% of patients, bone metastases appear which can lead to an increased risk of fractures, severe pain, immobility and consequently reduce the quality of life. “Therapy that uses hormone receptor antagonists ( substances that block the formation or binding of testosterone, so called “chemical castration”) is used to control advanced or metastatic disease (after surgery, radiotherapy or brachytherapy) or to prevent the disease from returning if the lymph nodes are invaded by cancer cells – he explains Sergio Bracarda, director of the Oncology Department and of the Complex Structure of Medical and Translational Oncology of the Santa Maria di Terni Hospital -. However, sooner or later there comes a time when the tumor develops resistance to conventional hormonal treatments and starts advancing again. It is precisely in this scenario that the data of the VISION study are inserted: the new targeted therapy with radioligand, in addition to showing a very promising clinical efficacy, represents an innovative therapeutic approach that does not interact with other drugs already available, in a disease ” complex “to be treated”.
The results of the study
177Lu-PSMA-617 is an experimental ligand therapy studied in metastatic castration-resistant prostate cancer: it is a precision anticancer treatment that combines a targeted compound (ligand) with a therapeutic radioisotope (a radioactive particle). “In practice 177Lu-PSMA-617 binds to prostate cancer cells that express the prostate specific membrane antigen (PSMA, present in about 80% of patients) and has the ability to act only on the tissues affected by the neoplasm saving everything around – continues Bracarda -. And the results of the trial presented during Asco indicate that adding this new drug to standard therapy improves both disease progression-free survival and overall patient survival by a few months. They are important results, which offer an option to patients who needed it and who promise to change what is currently considered standard therapy ». In patients treated with the addition of the radiopharmaceutical there was both a higher rate of adverse events related to therapy (85.3%) compared to standard of care alone (28.8%) and a greater number of interruptions of treatment due to side effects. “We are entering the era of precision medicine in prostate cancer with the VISION study – adds Procopio -. For the first time, the selective antitumor action of a radiopharmaceutical, Lutetium, is demonstrated in patients selected on the basis of an innovative diagnostic test such as PET PSMA ».
Symptoms that indicate an advancing tumor
VISION is a phase three study, the last one before the market entry of a new drug and based on the results achieved, two additional studies are being launched in the first lines of metastatic prostate cancer, with the aim of move towards the earliest stages of the disease. “Nuclear medicine uses radioactive substances to target cancer cells – concludes Ettore Seregni, director of Nuclear Medicine at the IRCCS National Cancer Institute of Milan -. The approach to a pathology such as prostate cancer must necessarily be multidisciplinary. In fact, the nuclear doctor works in a team with the oncologist and assesses whether the patient is a candidate for treatment with 177Lu-PSMA-617 by analyzing the results of the diagnostic PET performed previously. It is foreseeable that this therapy can be performed in many cases also on an outpatient basis, therefore without the need for hospitalization of the patient. The radiation emitted by the patient, in fact, is limited and the radioactivity disappears in a short time, so, following the appropriate precautions and indications, no risks for caregivers and family members are foreseeable “. Chronic fatigue, pain (especially in the bones), weakness, urinary disturbances, difficulty sleeping or doing normal daily activities, such as walking or climbing stairs. These are the alarm bells that should alert men with prostate cancer, because the presence of these symptoms could indicate that the disease is getting worse. Talking immediately with the oncologist, urologist or radiotherapist who is treating them is essential, so that you can immediately start the most effective therapy in their case with two purposes: to block the evolution of the cancer and maintain a good quality of life, without pain or other ailments, with advantages also on the extension of survival.
June 4, 2021 (change June 5, 2021 | 14:15)
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