Hormone therapy drug could halve risk of prostate cancer death

Prostate cancer researchers in Manchester in collaboration with colleagues in London and the wider UK have published game-changing results which could halve the risk of death for some patients with prostate cancer.  

The culmination of 6 years of research has found that adding abiraterone, a new type of hormone therapy, to the standard treatment for locally advanced prostate cancer, where the cancer has a high chance of spreading*, could halve the risk of death from the disease.   

These findings, from STAMPEDE, the world’s biggest clinical trial for prostate cancer, published in the medical journal The Lancet, show death rates for men with an aggressive form of prostate cancer where the cancer hasn’t yet spread, could halve if a particular treatment combination is used. 

The urological research team found that only 7% of patients died after receiving the new combination treatment for a period of 2 years, while 15% of patients died from prostate cancer while receiving the currently recommended treatment. It is therefore hoped that NHS England will use the findings of this research to change the standard care offered to this group of prostate cancer patients. 

Researchers including Professor Noel Clarke, urological surgeon and professor of urological oncology at The Christie NHS Foundation Trust in Manchester, said; “We now have very strong evidence that using abiraterone alongside the current standard treatments reduces prostate cancer deaths significantly in men with high-risk disease which has not yet spread beyond the prostate. Use of this combination therapy could improve outcomes for thousands of men every year.”  

Professor Noel Clarke, who is the UK’s co-principal investigator for the study added: “STAMPEDE is the only major high volume prostate intervention trial in the world in this type of prostate cancer and this research is a game changer for men with high-risk, locally confined disease. Up to 60% of prostate cancer deaths occur in men who present with this condition and the use of this drug combination would make a major difference to the chance of long-term survival following treatment in this patient population.”

The study, which has been running in its broader form since 2005, is funded by Cancer Research UK and the Medical Research Council (MRC)**.

Michelle Mitchell, Chief Executive of Cancer Research UK, said: “These results are the latest in a long line of practice changing findings from our STAMPEDE trial. It’s recruited over 10,000 patients and has led to 29 changes in clinical practice across the world, directly influencing the treatment of people with prostate cancer. It’s great to see that yet more people with prostate cancer could soon see benefit from this innovative research.” 

The trial is based at the MRC Clinical Trials Unit at University College London (UCL). This element of the study has followed patients over a six-year period. It was led by teams from The Christie in Manchester, UCL and The Institute of Cancer Research London, and over 130 urology/oncology departments across the UK, including the patients that they treat daily. 

The current standard treatment for this group of patients is a hormone therapy called ADT (androgen deprivation therapy) with radiotherapy to the prostate gland.

Up to 52,000 people are diagnosed with prostate cancer every year in the UK, and around 22,000 patients are considered at “high-risk” of their cancer spreading.  One third of those diagnosed have the aggressive form of the disease which is ‘localised’ meaning that it hasn’t spread to other parts of the body.

Abiraterone, which is taken in tablet form, is currently being used for patients with advanced prostate cancer which has spread to other parts of the body. It’s also given to people who have stopped responding to standard hormone treatment. It works by stopping the production of testosterone, which helps keep the disease under control, and is always given in combination with the steroid drug, prednisolone. 

Study co-leader Nick James, professor of prostate and bladder cancer research at The Institute of Cancer Research, London, and chief investigator of the STAMPEDE trial, said: “STAMPEDE continues to deliver practice-changing results. Currently, abiraterone is only given to patients with very advanced prostate cancer. Our latest findings are the first in the world to show the drug can also benefit men whose cancer is at an earlier stage - improving survival and reducing the chance of progression. The next step is for NICE to consider and implement our findings, so that men can benefit from abiraterone before their cancer has spread, drastically improving their quality of life and preventing many unnecessary deaths.” 

A total of 1,974 patients were enrolled across 2 arms of the trial with 988 given the current standard treatment and 986 patients given the standard treatment combined with abiraterone. These patients had nonmetastatic disease with or without spread to lymph nodes (locally advanced disease) and were enrolled at 113 UK and Swiss sites. 

 

* Patients with locally advanced prostate where the cancer has broken through the capsule (covering) of the prostate gland. It may have spread into: tissue around the prostate; the tubes that carry semen (seminal vesicles); body organs nearby such as the back passage (rectum) or neck of the bladder; or lymph nodes close to the prostate gland. 

** Funding was also provided by Janssen and Astellas. 

Last updated: March 2022