MISSION

This Group focuses on treating cancers of the urinary tract and male reproductive system. They are especially concentrated on clinical research for prostate cancer while actively researching on rarer diseases and biomarker-driven research.

PRACTICE CHANGING RESEARCH

Understanding prostate cancer: a global perspective

The prostate gland, found only in men, is positioned between the bladder and the rectum. Prostate cancer, the second most common cancer in men globally, accounted for nearly 1.4 million new cases and 375,000 deaths in 202028. It is the most diagnosed male cancer in over half of the world’s countries.

While higher-income countries have the highest number of diagnoses, deaths are more prevalent in the Caribbean, sub-Saharan Africa, and Micronesia/Polynesia. Screening in higher-income countries contributes to early detection, explaining the variations.

28 Sung, H. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 71, 209–249 (2021).

Prostate cancer patients who cannot be treated by lowering testosterone levels (c) and has spread to their bones typically receive the chemotherapy drugs Ra-223, enzalutamide, and abiraterone. PEACE III aimed to test the combination of enzalutamide (an AR pathway inhibitor) and Radium-223 as first-line treatment for patients with metastatic prostate cancer that no longer responds to hormone therapy and has spread to the bones.

This trial was a collaboration with several other cancer cooperative groups: Clinical Trial Ireland (CTI), the Canadian Urological Oncology Group (CUOG), the Latin American Cooperative Oncology Group (LACOG), and French UNICANCER cooperative group (GETUG). It took more than eight years to complete from first patient enrolled to the closing of the database.

PEACE-III shows that adding six cycles of Ra223 to enzalutamide as first-line treatment for mCRPC patients significantly improved patient outcome by increasing median progression free survival from 16 to 19 months.

PEACE III is the first major Phase 3 trial to suggest that combining an ARPI with another approved medication improves overall survival (OS) considerably. Previous Phase 3 studies that tested combinations of two ARPIs or combining an ARPI with a PARP inhibitor have failed to demonstrate a significant OS in the intent-to-treat population.

Toxicity from the treatment was mild, though the trial did illustrate the importance of giving bone protecting agents to avoid fractures. Given the improved efficacy and acceptable toxicity, the researchers concluded that the combination of enzalutamide and Ra223 can be a new valid treatment option for patients with mCRPC and bone disease and disease progression on androgen deprivation therapy.

Study coordinator: Prof. Bertrand F. Tombal

LATEST PUBLICATIONS

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