Prostate cancer, from Asco news in the therapies of the most serious cases

Prostate cancer, a cancer recently diagnosed in former US President Joe Biden, is the most common form of cancer among the over-50s. In Italy, it affects one in eight men. In 2024 alone, in our country, 40,192 new cases were estimated, according to data from Aiom and Airtum, collected in the volume 'The Numbers of Cancer in Italy 2024' which also highlight the constant growth in survival of Italian patients, attested at 91% 5 years after diagnosis. Like all cancer patients, those living with prostate cancer also aspire to live longer and better, to have drugs available that slow down the progression of the disease or even stop it.

And for patients with metastatic castration-sensitive prostate cancer, good news comes from Chicago, where the American Society of Clinical Oncology (Asco) meeting is underway: adding darolutamide to androgen deprivation therapy leads to a clinically significant improvement in health-related quality of life. Which means, in simple terms, that cancer pain appears later, as do urinary symptoms, and that patients report a more prolonged state of general, social and functional well-being than those who do not add this molecule to therapy.

The results of scientific studies evaluating the improvement in quality of life thanks to darolutamide and which also analyzed the efficacy of therapeutic combinations based on radium-223 dichloride in patients with bone metastases were presented at Asco. The results of the new post-hoc analysis of the Phase 3 Aranote study demonstrate a clinically meaningful improvement in health-related quality of life (HrQol) and the progression of pain was postponed in patients with metastatic castration-sensitive prostate cancer (mCspc) treated with darolutamide plus androgen deprivation therapy (ADT) compared to those treated with placebo plus ADT. Darolutamide prolonged the time to deterioration in the overall Functional Assessment of Cancer Therapy-Prostate (Fact-p) score, a predefined exploratory endpoint that represents the measure of general well-being, by 5 months compared to placebo, with a median of 16 months compared to 11 months.

"The results of the Aranote study clearly highlight a further positive role of darolutamide - underlines Orazio Caffo, director of Oncology at the Santa Chiara Hospital in Trento -. In addition to extending progression-free survival, it determines clinically significant delays in the deterioration of the quality of life, compared to hormone therapy alone. Prostate cancer can, in fact, determine important repercussions on daily life. The availability of new treatments capable of preserving the patient's well-being at 360 degrees and delaying the progression of pain is fundamental".

Also at Asco in Chicago, data from two clinical trials evaluating radium-223 dichloride in patients with metastatic castration-resistant prostate cancer with bone metastases were presented. This is the first and only alpha-emitting radiopharmaceutical approved for the treatment of this type of patient. The results show that the addition of radium-223 to enzalutamide, an inhibitor of the androgen receptor pathway (ARPI), causes a positive action on some parameters that are indicators of tumor activity. The combination had already demonstrated its efficacy in increasing survival free from radiological progression, with a 31% reduction in the risk of progression or death compared to the administration of enzalutamide alone.

"The new analysis from the Peace III study provides further useful information on the benefits derived from the therapeutic combination - says Ugo De Giorgi, director of the University Oncology at the Vito Fazzi Hospital in Lecce -. We are encouraged by these results with the combination therapy with radium-223 dichloride which has demonstrated improvements in the response to both PSA and ALP, in addition to the improvements in survival already known. This is therefore a further possible treatment option for those patients affected by metastatic castration-resistant prostate cancer, including those patients who require a more decisive clinical response, which sometimes hormonal therapy alone is not able to provide".

Data from another phase 2 study - Comrade - were also presented in Chicago, showing that the combination of olaparib with radium-223 chloride significantly improved progression-free survival in patients with metastatic castration-resistant prostate cancer compared to radium-223 chloride alone.

"These results reflect our ongoing commitment to redefining prostate cancer care and improving patient outcomes across the various stages of the disease. We are focused on innovative therapies that address the full spectrum of cancer patient needs and aim to improve the overall treatment experience," said Christine Roth, Executive Vice President, Global Product Strategy and Commercialization and member of Bayer's Pharmaceuticals Leadership Team.