According to two recent studies, abiraterone, a drug for prostate cancer treatment, was found to increase survival in patients with advanced prostate cancer when given before chemotherapy. These encouraging results were published in Lancet Oncology.
A previous study had found that patients that took abiraterone before chemotherapy decreased cancer progression time, but did not improve overall survival, with NICE guidelines rejecting abiraterone treatment before chemotherapy.
The results of this study coincide with findings from a clinical trial, recently reported by researchers at The Institute of Cancer Research (ICR) and The Royal Marsden and published in Clinical Cancer Research, that found a subgroup of patients with advanced prostate cancer could benefit from abiraterone given prior chemotherapy. In fact, abiraterone is already in the HS recommendations as a drug prescribed to patients after chemotherapy.
In the first study, the research team led by Professor Johann de Bono, Professor of Experimental Cancer Medicine at The Institute of Cancer Research, London, and Honorary Consultant at The Royal Marsden NHS Foundation Trust, assessed overall survival in a total of 354 patients who received abiraterone before chemotherapy, comparing them with 387 patients who received placebo. The results showed that patients who received abiraterone lived on average 34.7 more months that patients who did not received the drug. Furthermore, results showed that abiraterone is safe, as only a few patients experienced adverse effects.
Results from the second study used patients from the same trial, and revealed that abiraterone benefits a subgroup of patients who experience an aggressive type of prostate cancer. Through genetic analysis of tumor samples (specifically targeting the ERG gene), the researchers examined data of 348 patients who received either abiraterone or a placebo. The analysis showed an association between mutations in ERG and response to abiraterone. The drug improved survival (independent of ERG mutations), however, in a subgroup of patients (15%) who carried ERG mutations, abiraterone was particularly efficient. Patients from this subgroup had an extended life of 22 months without disease progression.
“These two new studies, from a major trial of abiraterone in men who are yet to receive chemotherapy, both represent very significant advances. In the overall trial analysis, we’ve shown definitively that the drug extends life if taken before chemotherapy, by an average of around four months. The second study shows that men with a particular type of genetic mutation in their tumor respond particularly well to abiraterone, and importantly that a subset of patients with a very bad outlook respond best of all,” Professor Bono said in a news release. “Those results could help provide a rationale for using abiraterone as early as possible in men with these mutations. Currently, men are not generally tested for mutations in their cancer over time — which is why a major focus of our research is on developing new tests to monitor cancer’s genetic progression in individual men, and ultimately match their disease to the best possible treatment.”
Professor Paul Workman, Chief Executive of The Institute of Cancer Research, London, further explained, “Abiraterone has already transformed care for patients with advanced prostate cancer, but the latest trial evidence strengthens the already powerful case for it to be accepted for NHS use earlier in the course of treatment. Not only do the overall results find that abiraterone significantly extends lives when used before chemotherapy, but the second study shows it is possible to pick out a subgroup of men who benefit especially strikingly.”
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