Approval of targeted therapies first line for prostate cancer ‘will ease Covid-19 pressures’

The Institute of Cancer Research, London, has broadly welcomed the approval of targeted hormone therapies enzalutamide and abiraterone as first-line NHS treatments for men with advanced prostate cancer.

Its experts said newly published interim guidance by NHS England was an example of how modern treatments that can be taken at home could relieve pressure on the NHS during the coronavirus pandemic.

But The Institute of Cancer Research (ICR) was also critical of NHS England for taking so long over its recommendation, and for limiting use of abiraterone only to patients who could not take enzalutamide.

Standard treatment for men when they are first diagnosed with advanced prostate cancer is hormone therapy – either on its own, or together with docetaxel chemotherapy.

Docetaxel is normally given as six three-weekly infusions in hospital and can significantly weaken patients’ immune system and cause inflammation of the lungs – putting men at risk during the current Covid-19 pandemic.

Treatment with enzalutamide or abiraterone can not only prevent patients having to receive docetaxel chemotherapy but is also given as tablets which men can take at home – avoiding unnecessary pressures on the NHS.

NHS England has updated its interim guidance on treatment change options during the Covid-19 pandemic to offer enzalutamide for men with newly diagnosed, advanced prostate cancer – and abiraterone for patients who cannot tolerate enzalutamide.

Abiraterone is a highly innovative treatment which was discovered at The Institute of Cancer Research (ICR), and which we jointly developed with The Royal Marsden NHS Foundation Trust. The ICR and The Royal Marsden also led a major phase III clinical trial of enzalutamide.

Two large clinical trials, STAMPEDE and LATITUDE, found that men given abiraterone first line lived longer, and had a better quality of life, than those given hormone therapy with docetaxel chemotherapy.

Abiraterone was licensed as a first-line treatment by the European Medicines Agency (EMA) in 2017, and was recommended in Scotland as a first-line treatment for advanced prostate cancer earlier this year.

However, in England and Wales, it has only been available to treat men for whom hormone therapy has stopped working.

In light of the Covid-19 pandemic, the ICR’s Professor Nick James and more than 80 colleagues across the UK wrote to NHS England and the Cancer Drugs Fund urging them to widen earlier access to abiraterone for men across the UK.

Professor Nick James, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London, and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, is Chief Investigator of the STAMPEDE clinical trial, which is exploring the best way to treat newly diagnosed advanced prostate cancer.

Professor James said:

“I’m pleased and relieved that many more men should now benefit from targeted hormone therapies right from when they are first diagnosed. They are smarter, kinder treatments, and could extend the lives of many more patients.

“Offering enzalutamide or abiraterone to men as first-line treatment for prostate cancer will greatly lower the risk of exposing vulnerable patients to the coronavirus, and lightens the load on our hard-pressed hospitals. Men can take their tablets at home and have their bloods checked by their GP – and unlike chemotherapy enzalutamide and abiraterone have no significant effects on patients’ immune system.

“It is however frustrating that during this anxious lockdown period it has taken so many weeks to agree extended access to targeted hormone therapies in place of chemotherapy, and that NHS England has chosen to focus on enzalutamide as the initial therapy rather than leaving clinicians to decide on an individual patient basis. It’s becoming increasingly clear that the Covid-19 pandemic will have a long-term impact on the way we live our lives, and I would urge NHS regulators to consider other areas in which cancer care can be modernised, to move towards managing patients at home where possible.”