Dr Matthew Hobbs, our Deputy Director of Research, shares his highlights from the world’s largest conference on genitourinary cancers and explains how new research could lead to more effective treatment for men with prostate cancer.

Matthew Hobbs, Deputy Director of Research
25 Feb 2019

Last week was the world’s biggest meeting of clinicians and scientists focused on improving care for genitourinary cancers, including prostate cancer. Conferences like this are a great opportunity to hear about the latest discoveries that have real potential to change men’s lives. Here, I wanted to share some of my highlights and explain some of the new avenues being explored in prostate cancer research.

Making radiotherapy quicker, better and cheaper

The highlight of the conference for me was a presentation by Professor Nick Van As from the Royal Marsden Hospital. He summarised early results of the PACE-B trial, which compares standard radiotherapy with a higher dose technique that allows the entire treatment to be done in five hospital visits within a single week. This is significantly faster than the normal time-frame of five visits per week for four to eight weeks. But increasing the intensity of the radiation doses in each visit is no joke. The researchers needed to check that this wouldn’t cause serious and immediate side effects, such as bowel or bladder problems. Excitingly, the researchers showed there was no difference in side effects after the first 12 weeks between the intense and normal radiotherapy.

Over the next two years, the research team will track the long-term side effects and how often cancer comes back for men treated on this trial. At that point, if the results remain positive, we’ll call for this new, more intense form of radiotherapy to be made available to men in the UK.

PARP PARP: coming through!

You may have heard us talk about PARP inhibitors before – these are drugs that were designed for use in ovarian cancers but are showing promise in some prostate cancers too. This story is moving quickly and a number of different drug companies are now trialling different PARP inhibitors in prostate cancer. Over the next 12–18 months, we will learn the results from some of these big trials, but it became very clear from this conference that learning how to identify the men who will benefit from these drugs is key.

At the moment, researchers are testing lots of different approaches and the results aren’t always identical, so it might mean that these drugs are introduced first for a smaller number of men who will definitely benefit. Further development and finding ways to combine PARP inhibitors with other drugs might be needed to increase the number of men who could benefit.

Either way, it’ll be exciting to see the first definitive results of a completely new way to treat prostate cancer over the next year or so. Not least because our funding contributed to showing that this was a viable option for prostate cancer, which has opened up a whole new field of study.

Targeted radiation to treat metastatic disease

Last year, we saw some positive results from Australian researchers who’d been testing a completely new way of treating hormone-therapy resistant prostate cancer that has spread around the body. This is called LuPSMA and involves delivering a radioactive payload (Lutetium-177) directly to prostate cancer cells around the body by targeting a protein called Prostate Specific Membrane Antigen (PSMA) that is found on the surface of prostate cancer cells. The idea is that by targeting the radiation precisely to the cancer cells, it will destroy them wherever they are in the body but cause minimal harm to healthy tissue. This was initially tested in just 50 patients and the results were promising. At this conference, we heard more about two much bigger trials that will test LuPSMA, one comparing it to current standard treatments, and the other comparing it to chemotherapy. These will involve longer follow-up to work out whether the promising early results mean that men live longer with this treatment.

Although this is being run by teams in Australia, there’s interest in testing LuPSMA in the UK too. In fact, it looks like several UK sites will be included in these next trials. However, before they can take part in the trial, men need to have a particularly sensitive type of imaging, called a Ga68-PSMA PET scan. At the moment, this imaging technique is not yet widely available in the UK, so we’re working with researchers, clinicians and NHS commissioners to make sure this won’t be a barrier to men accessing this treatment if the results are positive.

Going all guns blazing

We’ve previously talked about the ADRRAD trial, which we’ve part-funded in the Belfast-Manchester Movember Centre of Excellence. This is a small clinical trial to test whether the side effects are tolerable when giving men radiotherapy to the prostate, plus radium-223 to target cancer that’s spread to the bones, shortly after they’ve had hormone therapy and docetaxel chemotherapy. This is really going all guns blazing on advanced disease, and the results presented at the conference suggest that the treatment was well-tolerated and there were no unexpected side effects. We’ll have to wait for the full results to be published to say more about this, but I was excited to find out that this treatment combination will now be tested on a large scale in the STAMPEDE trial. Being included in a well-established trial like STAMPEDE will shave years off the set-up and recruitment time for the trial, so if the results are positive, the treatment can reach men sooner.

That was just one of several posters presenting work funded by Prostate Cancer UK this year. Each year there seems to be more UK-led research being presented at these global conferences, and more and more that we’ve funded. This kind of global impact, which will eventually change practice for men, simply couldn’t happen without the generosity and commitment of our supporters, as well as a huge amount of hard work and excellence from the researchers we fund across the UK. So it’s a big thank you from me to everyone who’s helping us to deliver a longer and better life for men with prostate cancer.

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