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Innovations in Oncology 2021

Embracing targeted treatments for prostate cancer

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Professor Johann de Bono

The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust

The treatment options for someone diagnosed with advanced prostate cancer have improved dramatically over the past decade.

Research has driven developments in drug therapies and radiation therapies, as well as combinations of the two.

Where treatment might once have been ‘one-size-fits-all’, we are getting better and better at tailoring treatment for each patient – targeting a person’s tumour specifically.

Promising new treatment options

Just recently we presented promising results at the ASCO conference of a large trial of a new high-tech drug treatment, which delivers a dose of precisely targeted radiation to prostate cancer cells.

We found that this new treatment, which acts like a guided missile, seeking out cancer cells with high levels of a molecule called PSMA on their surfaces, can keep patients alive and healthy for four months longer than standard care.

The key thing is that targeted treatments like this can help prostate cancer patients live relatively normal lives because the side effects are much less than with more conventional treatments.

Impact of COVID-19 pandemic

During the COVID-19 pandemic, doctors have been able to use targeted hormone therapies more freely because they have meant men with prostate cancer would then not have to go into hospital for more aggressive treatments, which would also often weaken the immune system making someone more susceptible to an infection.

Abiraterone has already benefited hundreds of thousands of men around the world – discovered at the ICR and developed in partnership with The Royal Marsden NHS Foundation Trust, the drug was one of the first of many more targeted therapies for advanced prostate cancer.

Where treatment might once have been ‘one-size-fits-all’, we are getting better and better at tailoring treatment for each patient – targeting a person’s tumour specifically.

For example, one which we expect to become widely available soon as a treatment for some men with prostate cancer, is the precision medicine olaparib. We’ve had extremely positive results from large trials assessing this drug. Known mainly as a breast and ovarian cancer drug. We’ve found that the therapy can be effective in men who have mutations in specific genes involved in DNA damage repair, such as BRCA1 and BRCA2.

Treatments like this, which rely on understanding the fundamental biology of the disease, demonstrate why laboratory research – as well as clinical science – is needed in the search for smart new treatments.

Risk of resistance

After all, over time, cancer can evolve resistance to treatment and return. So no matter how effective a targeted treatment is, we must also be mindful of the risk of resistance. That’s why we’re so dedicated to discovering and developing even more new treatments that give men with advanced disease more options and are dedicated to finding ways to delay or prevent resistance all together.

As cancers develop, they often evolve the ability to evade the immune system so they can keep growing and spreading. We are currently working on understanding and targeting a protein known as CD38, displayed on the surface of immune cells.

CD38 dampens down the immune response against prostate cancer. We believe that existing therapies which target CD38 could hold promise against prostate cancer too, by reawakening the anti-cancer immune response and fighting cancer’s ‘cloaking’ strategy. I’m leading a clinical trial in this area, which is a first in prostate cancer.

There are many reasons for optimism and I’m confident we’re going to make even more progress in better targeting prostate cancer treatment so we can help many more men live longer, while enjoying a good quality of life, in the decade to come.

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