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Late stage prostate cancer needs our full attention
Oncologist Prof. Johann De Bono is involved in search for new prostate cancer treatments
“Late stage prostate cancer remains an obvious and large unmet clinical need”, says Prof. Johann De Bono, oncologist at The Royal Marsden Hospital in Sutton (UK). “It is good to see that during the 2nd European Multidisciplinary Meeting on Urological Cancers, to be held in Barcelona (ES) from 26-29 November, a great deal of attention is paid to prostate cancer”.
According to Professor De Bono, prostate cancer is not hormone refractory but truly remains hormone ligand driven. “We have performed several studies with the CYP17 inhibitor abiraterone acetate which tell us that this is the case”. Abiraterone acetate is a potent, selective, and orally available inhibitor of CYP17, the key enzyme in androgen and estrogen biosynthesis. “CYP17 blockade by abiraterone acetate results in declines in PSA values and radiologic responses, which confirms that CRPC commonly remains hormone driven”, says De Bono.
Thus a great deal of research is being performed in this area. One of the promising new compounds under investigation is MDV3100, which recently entered a Phase III clinical trial – the AFFIRM study - for the treatment of castration-resistant prostate cancer (CRPC). Prostate tumours that have stopped responding to, or are growing despite the use of, active hormone treatment strategies are characterised as castration-resistant. According to Professor De Bono, who is actively involved in the trial, these patients have few treatment options and a poor prognosis. “They are in great need of better treatments. One of these may be MDV3100, a potent androgen receptor antagonist which slows growth and induces cell death in CRPC”.
MDV3100 was discovered in the laboratory of Charles Sawyers, Professor at UCLA (Los Angeles, US) through experiments investigating castration resistance. The initial trial focuses on patients with advanced disease. “Many earlier stage prostate cancers progress to cause widespread metastases, often rapidly, to late stage disease. Therefore our ultimate goal is to develop a compound that treats the broadest possible spectrum of prostate cancer disease states. We believe that patients with earlier-stage disease may also benefit from MDV3100 and we look forward to expanding development to include those patients in potential future studies”, says De Bono.
“In any case, the treatment of CRPC will evolve rapidly over the next 5 years. Multiple new agents will become available. CRPC will increasingly become a chronic and manageable disease”, concludes Professor De Bono.
