A New Chance for Patients with Advanced Prostate Cancer
Although prostate cancer remains a taboo subject for many men, more and more celebrities are admitting to having this cancer. Many stories have a positive ending – early detection of cancer, full recovery. But what happens when the cancer is detected at an advanced stage, or, much more difficult, when it returns?
Currently, many new hormonal drugs are available in Poland that can stop the further development of prostate cancer for many years. Unfortunately, none of these therapies will stop the progression of advanced disease, i.e. will not cure it. When castration resistance occurs, i.e. progression to the next stage, prostate cancer changes from a chronic disease into a rapidly progressing fatal disease. What does this mean? From the moment of hearing the diagnosis of metastatic castration-resistant prostate cancer (mCRPC), on average only 3 out of 10 patients will live to see five years.
Experts confirm that prostate cancer can be managed very well for many years. There are patients who, despite the advanced stage of the disease, live to a ripe old age. Not every patient will die from this cancer, because not everyone’s cancer progresses to mCRPC, or metastatic castration-resistant prostate cancer. However, when this happens, it is a completely different disease, much more difficult to treat. With a much worse prognosis.
For patients diagnosed with mCRPC, it will be very important to stay at this stage of the disease as long as possible – to maintain the time free from further progression. This is the last moment to administer intensive but effective treatment, because the patient is still in a good general clinical condition. It must not be forgotten that oncological treatment is always a burden for the entire body, which in turn becomes weaker due to the disease. That is why it is so important to adjust the therapeutic strategy to the patient’s capabilities, to their tumor, and physical condition. Such optimal treatment administered at the very beginning can postpone the progression of the disease for a long time. According to the results of the study, a chance for patients suffering from mCRPC may be the combination of two well-known mechanisms of action: NHA – a modern hormonal drug – abiraterone acetate and a PARP inhibitor – olaparib. This combination in the group of patients who had not been previously treated with NHA gave an unprecedented extension of the time free from progression, as much as 2 years. The median overall survival time was as much as 42 months. Importantly, these results are not dependent on the molecular status. How is this possible? Combining olaparib with abiraterone makes both inhibitors work more effectively. NHA makes the cell behave as if it had a mutation BRCAand as a result – becomes sensitive to the action of iPARP. In turn, iPARP causes a decrease in the number of androgen receptors, the presence of which is necessary for the survival of cancer cells. Currently, each of the molecules is already successfully used separately in the treatment of prostate cancer. NHA is the standard of treatment, and iPARPs are used in monotherapy, in subsequent lines of treatment, in patients with mutations in genes BRCA.
Currently in Poland, despite access to many modern therapies, patients are still often treated suboptimally. The most common culprit is the lack of ordering patients with appropriate molecular diagnostics, the results of which are crucial for receiving or not receiving effective therapy. Each new treatment option that does not require additional tests and can be used “regardless of molecular status” is a chance for patients. Combination therapy with olaparib and abiraterone may be just such a chance for patients with prostate cancer.
