Different trials and different medicines combined with each other achieve important goals for patients with already metastatic cancer or at high risk of progression
Extend survival and improve the quality of life of patients with a more aggressive form of prostate cancer which, with about 36 thousand new cases identified in 2020 in Italy, is the most frequent type of cancer among males in our country. These are the objectives to which many researches presented during the last congress of the European Society of Medical Oncology (ESMO) aim. Thanks to early diagnosis and scientific advances today 90% of patients are still alive 10 years after diagnosis: an important milestone, especially if we consider that a form of cancer typical of old age and that most patients are over 70 years old. In a high percentage of cases, however, the disease evolves into a form resistant to therapy and metastasizes. The results of two trials presented at the European conference indicate that a new combination of drugs, already widely known, can prolong the life of men with hormone-sensitive prostate cancer and the results of another study indicate that it is possible, in those who have a metastatic form resistant to hormonal therapy, stem pain and delay worsening in everyday life.
A triplet to slow the disease in those with many metastases
When the cancer 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 a reduction in quality of life. The standard treatment for men with metastatic prostate cancer has been hormone therapy for decades: the testosterone produced by the male testes, in fact, stimulates the growth of the tumor and hormone therapy tries to counteract this action by slowing down or blocking the synthesis of testosterone (deprivation androgenic). In 2015, then, it was shown that adding the chemotherapy docetaxel improved the survival of patients and in 2017 the same result was achieved by administering, together with hormone therapy, a new generation hormonal agent, abiraterone. But which of the different options was the best mix until now was unclear. The results of the PEACE-1 study, presented at the ESMO 2021 congress, indicate that using all three drugs (androgen deprivation, plus docetaxel, plus abiraterone) is the best solution especially for men with a very aggressive neoplasm, with multiple metastases. This is the first trial to indicate that patients with hormone-sensitive metastatic prostate cancer should be offered the triplet, even considering that the side effects were mostly mild and the treatment well tolerated. Karim Fizzazi, medical oncologist of the Gustave Roussy Institute of Villejuif, France, and first author of the research -. In this way we were able to add two and a half years without the disease progressing: for the first time these men can expect to live beyond five years from diagnosis, while previously the average was less than three.
New mix to extend life and stave off metastases in those who don’t have them
The STAMPEDE study, on the other hand, focused on patients with hormone-sensitive, localized prostate cancer, that is, without metastases, but at high risk of developing them. About 20% of cases at the time of diagnosis in this situation and men generally receive hormone therapy for two to three years combined with prostate and pelvic radiation therapy to prolong survival. Previous research has indicated that adding docetaxel chemotherapy delays the time when the disease progresses, but does not lengthen the lives of sufferers. Participants in the trial were given hormone therapy alone or in combination with abiraterone and predinisone. The conclusions indicate that all patients with this type of cancer should be evaluated to receive an additional two years of abiraterone – explained the study’s lead author Gerhardt Attard, of the Urological Cancer Research Center at University College London. In this way, both the period before the onset of metastases and the life span of the patients are lengthened. Now we have to evaluate whether the treatment has the same effects given for a shorter period or if, by taking it longer, even better results can be obtained.
New cure to improve the quality of life
Finally, a third trial (VISION) involved 831 patients with metastatic castration-resistant progressive prostate cancer, who are treated with 177Lu-PSMA-617, a new targeted radioligand therapy, in addition to the best standard of care. Numerous patients with this type of neoplasia complain of physical disabilities and considerable pain because bone metastases can lead to an increased risk of fractures, great suffering, immobility and consequently reduce the quality of life. The results of the trial indicate that, with the new drug, the daily life of patients improves and the onset of the most disabling symptoms is delayed. A non-negligible component of metastatic prostate cancer is the particularly debilitating symptomatology and cause of further complications for the patient’s state of health and psycho-physical well-being – commented Giuseppe Procopio, head of the genitourinary medical oncology of the IRCCS National Institute Foundation of the Tumors of Milan -. To confirm the importance of the data of this study presented at Esmo 2021, the fact that radioligand therapy opens up a new perspective, revealing itself to be an effective therapeutic option, able to offer patients, together with good tolerability, also a favorable prognosis in terms of duration and also of quality of life. The efficacy and safety data of the VISION study were presented at the last American Asco congress, in which oncological therapy with radioligand in addition to the best standard of care achieved a reduction of both the 38% risk of death and 60% of the risk of disease progression. Now it is possible to start thinking about personalizing therapeutic choices in an extremely precise way, allowing a better prognosis even to the most complex patients, for whom all this translates into an increase in the duration and quality of life – he concludedMarcello Tucci, director of Oncology at the Cardinal Massaia Hospital in Asti -. For patients with metastatic prostate cancer the scenario today is quite different from a very short time ago and still in continuous, very rapid evolution as in few other sectors of oncology. The latter of the VISION trial underline the positive results on the quality of life, confirming the potential of this treatment.
October 7, 2021 (change October 7, 2021 | 10:00)