Apalutamide delays spread of certain prostate cancers in trial

Healthy Men

However, the therapy eventually stops working for nearly all patients, leading to what is called castration-resistant disease.

Overall, 12.1 percent of the 1,162 men included in the analysis were found to have carried one or more pathogenic variant, which was significantly higher among men with a personal history of cancer and another cancer (14.7 percent) compared with men who only had prostate cancer before (10.6 percent). The key finding is that more than 12 percent of men with prostate cancer had an inherited (i.e. hereditary) mutation in a cancer-causing gene.

"We believe hereditary cancer testing can help inform treatment decisions for these men, including whether to pursue active surveillance, increased screening for secondary cancers and potentially for treatment selection with PARP inhibitors or other medicines in the future", said Dr. Lancaster.

Both apalutamide and enzalutamide battle prostate cancer by binding to the androgen receptor on tumor cells, blocking its activation by testosterone and other male hormones, explained Dr. Oliver Sartor, medical director of the Tulane Cancer Center in New Orleans. Both drugs were tested against a placebo. Patients were randomised 2:1 to receive apalutamide in combination with androgen deprivation therapy (ADT) (n = 806), or placebo in combination with ADT (n = 401). The drug extended progression-free survival by almost two years over placebo - 39.6 months versus 17.7 months - and decreased risk of cancer migration by 71 percent, according to results from more than 1,400 patients.

Adjuvant docetaxel therapy may have a negative impact on disease progression post-prostatectomy among patients with prostate cancer with low or undetectable prostate-specific antigen (PSA) levels, according to a study presented at the 2018 Gastrointestinal Cancers Symposium in San Francisco, California.

The aim is for the drug to be used at this stage and help delay the spread of the disease to other parts of the body - a setting for which there are now no approved treatments in the U.S. or Europe.

ADT, either through surgical removal of the testicles or the use of drugs that suppress testosterone production, is standard treatment for men with metastatic prostate cancer and is also used for nonmetastatic cancer.

Unpublished clinical trial results of a different hormone therapy, enzalutumide (Xtandi), were presented at the same conference.

In particular, the prevalence of the BRCA2 mutation appeared to be higher in men with only prostate cancer, and mismatch fix mutations were higher in men with additional cancer history, of which most had cancers associated with Lynch syndrome.

Further, neither trial was created to test whether these men gained any overall survival benefit by having their prostate cancer treated before it spread to other parts of their bodies, Sartor said. "I think these trials absolutely are providing new data, but I'm not personally convinced that someone with non-metastatic disease ought to be receiving these drugs".

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