ICR welcomes new advanced prostate cancer treatment guideline

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

Standard treatment for men first diagnosed with advanced prostate cancer is hormone therapy – either as monotherapy or together with docetaxel chemotherapy.

Docetaxel is generally 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, ICR experts note.

They say 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 now 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.

The move follows pressure from experts to widen access to abiraterone during the novel coronavirus pandemic, given that first-line treatment with the drug is available on the NHS in Scotland, and data show survival and quality of life improvements over hormone therapy/docetaxel.

“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,” said Professor Nick James, Professor of prostate and bladder cancer research at the ICR, and consultant clinical oncologist at The Royal Marsden NHS Foundation Trust.

“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.”

Abiraterone was discovered at The Institute of Cancer Research (ICR) and 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.

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