Wednesday 1 March 2023

A new treatment for prostate cancer trialled at The Christie NHS Foundation Trust in Manchester has shown to be more effective for the hardest to treat form of the disease.

This study is aimed at helping men where the cancer has spread to other parts of their body and the tumours keep growing even when the testosterone in the body is reduced to very low levels.

Dave Kinsey (68) from Winstanley in Wigan, Greater Manchester, a retired civil engineer, and keen cyclist, was diagnosed with an aggressive form of prostate cancer in February 2016 when a blood test found his PSA level (an indication of whether a man has prostate cancer) was 36 (4.0 and lower is considered normal). The tumours had spread to his lymph nodes and spine and he immediately went on his first clinical trial at The Christie which brought his PSA level back to normal.

In March 2019, after his PSA level started to rise again, doctors looked for another option for him and he became one of the first patients to sign up to PROpel, a phase 3 clinical trial which had recently opened at the National Institute for Health and Care Research (NIHR) Manchester Clinical Research Facility (CRF) at The Christie.

Dave Kinsey, 68, participant in the PROpel trial
Dave Kinsey, 68, participant in the PROpel trial

As part of the trial, Dave, who is married to Jill and has two daughters and two granddaughters, was given a testosterone blocking drug, abiratone, combined with olaparib, a targeted cancer drug which blocks a DNA repair enzyme in the cancer cells called PARP. This drug combination reduced his PSA level to less than 0.1 in under 5 months and now Dave has no signs of active cancer. Although the PROpel trial closed in October 2022, Dave has continued taking this drug combination.

Results from the phase 3 trial show that abiratone, given in tablet form, combined with olaparib, could extend the life of patients with stage 4 prostate cancer by an average of 7.4 months compared to standard therapy using abiraterone alone.

Abiraterone is currently being used for patients with advanced prostate cancer which has spread to other parts of the body. It is 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 with the steroid drug, prednisolone.

Introducing olaparib to the treatment means chemotherapy may not be needed, thereby avoiding possible unpleasant side-effects which could have an impact on their quality of life.

The combination of abiratone with olaparib has now been approved by the European medicines gegulatory authority and it is soon to be considered by NICE (The National Institute for Health and Care Excellence). It is hoped that this effective treatment will be made available more widely on the NHS.

An article about the PROpel clinical trial, which is co-authored by Professor Noel Clarke, consultant urological surgeon at The Christie and Salford Royal and honorary professor of urological oncology at The University of Manchester, has been published in the New England Journal of Medicine. Further important results were recently presented at GU ASCO, one of the world’s leading prostate cancer conferences in San Francisco.

The Christie research team, working with other international collaborators, found that the combination of olaparib and abiraterone decreased substantially the rate of progression of prostate cancer and there was a seven-month improvement in men receiving the combination treatment compared to abiraterone alone.

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Professor Noel Clarke, Urological Surgeon at The Christie and Professor of Urological Oncology at the University of Manchester, who is the joint global lead for the PROpel trial, said:

“Patients with advanced prostate cancer have an average of three years to live, so this drug combination buys them a significant amount of extra time to enjoy life. This is a genuine advance in the treatment of this type of aggressive prostate cancer (metastatic castration-resistant prostate cancer) and its effect will have an influence on prostate cancer treatment around the world.”

“The Christie prostate cancer team has made a substantial contribution to the development and success of this new therapeutic approach, illustrating the importance of combining laboratory science with the clinical work involving patients. This new drug combination shows a significant benefit to prostate cancer patients, and it will help extend the lives of men unfortunate enough to develop this common and unpleasant disease.”

“We recommend that this treatment should be considered as an alternative to chemotherapy when a patient’s metastatic prostate cancer progresses after their initial treatment following diagnosis, and, ultimately, we believe that this type of therapy will become the “go-to” treatment for most patients in this specific group.”

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Dave Kinsey, commenting on being in the PROpel clinical trial, said:

“Initially I was told I had three to five years to live, so I’m very pleased with the trial as it has stopped the cancer from spreading. Although the hormone therapy makes me a little tired, I can enjoy looking after my granddaughters, long walks with the dog and getting out on my bike.”

“I’d recommend going on a clinical trial to anyone who needs it. You are very well looked after and regularly monitored so you have nothing to worry about.”

Almost 800 men globally participated in the PROpel study, which was funded and supported by Astrazenca and Merck pharmaceutical companies.

Professor Noel Clarke was joint global chief investigator of PROpel together with Professor Fred Saad from the University of Montreal.