NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Prostate cancer: recent advances

In recent months there have been significant developments in the treatment in advanced prostate cancer.  Most prostate cancers depend on androgens, principally testosterone, for growth and survival. In metastatic disease, first line treatment is androgen deprivation therapy; usually pharmacological castration with luteinizing hormone releasing hormone agonists like triptorelin. Once these treatments fail, patients are considered to have castration resistant prostate cancer (CRPC) which has limited treatment options and, with a growing burden of symptoms, prognosis is generally poor. 

 

Docetaxel: Docetaxel improves overall survival and quality of life. Until recently, it was reserved for patients with metastatic CRPC, albeit, for a variety of clinical reasons, less than half of these patients would receive it. The 2015 STAMPEDE trial demonstrated improved overall survival in men with metastatic prostate cancer which was not yet castration resistant.  The West of Scotland Clinical Management Guideline was quickly changed to make this available much earlier in the pathway.

 

Abiraterone: This oral drug works by inhibiting the chemical synthesis of androgens in the adrenal glands and tumour cells. Its license, previously restricted to patients who had failed docetaxel chemotherapy, now includes use in patients with asymptomatic or mildly symptomatic metastatic CRPC after failure of androgen deprivation therapy where chemotherapy is not yet indicated.  This earlier use is associated with extended progression free and overall survival. It is SMC accepted and is an option within the regional guideline. Enzalutamide, an androgen receptor signalling inhibitor, is licensed for the same indications but, at present, is only SMC approved for use after docetaxel.

 

Full details for all of these treatments and the Clinical Management Guidelines can be found on the WOSCAN intranet site available here.  (NHS network access required)