Prostate cancer patients living longer thanks to UCL research

Until recently, men with advanced prostate cancer had a bleak prognosis. UCL clinical research has shown three new treatment options, added to standard therapy, can help patients live longer. 

Prostate cancer is one of the most common cancers. In 2013, it affected more than one million men across the world. But standard therapy for prostate cancer had not changed for more than 40 years.  

 A number of findings from the UCL-led STAMPEDE clinical trial have reliably shown that three new treatments, when added to standard therapy, can each help men with prostate cancer to live longer.  

The UCL-led STOPCAP M1 collaboration involved Professors Matt Sydes, Mahesh Parmar, Jayne Tierney and colleagues from the MRC Clinical Trials Unit at UCL. They combined in meta-analyses the results of STAMPEDE with similar trials to get a more complete picture of the effects of these treatments.

These results rapidly changed treatment guidelines and the treatment of men in the UK and worldwide. These included NHS NICE guidelines, the US National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology (ESMO). 

Innovative new trial design  

STAMPEDE involved more than 12,000 men and was the first to make full use of a new, efficient, clinical trial design called a ‘MAMS (multi-arm multi-stage) platform trial’. This ‘multi-arm’ part of the design allows researchers to compare, at the same time, a number of promising treatments to standard therapy.

By using this new trial design, UCL delivered findings that might have taken decades if a series of trials had been done instead. The ‘multi-stage’ part of the MAMS approach identifies early those treatments which are unlikely to be helpful. Traditional trial designs cannot do this efficiently. The ‘platform’ element allows new treatments to be added for assessment in the trial – working together rather than having multiple trials trying to recruit the same people. This element also allows assessment of new questions to start quickly at hospitals. 

The STOPCAP meta-analyses used another new approach developed by UCL called ‘FAME’. This involves planning how to combine trial results before they are even known by anyone. This means researchers can find out the effects of treatments more quickly, reliably and thoroughly than other types of meta-analysis.  

Preserving extra years of life  

STAMPEDE and STOPCAP together provided strong evidence of which men would live longer, when given either docetaxel chemotherapy or abiraterone hormone treatment, or radiotherapy to the prostate, alongside standard treatment. These men also have a lower risk of their cancer returning meaning that subsequent treatments, and any toxicities that might cause, can be put off for longer. 

These results were between 2015 and 2018. By 2019, it is estimated that 36% of patients in the UK (around 2,500 men each per year) were receiving docetaxel as part of their standard therapy. This means men diagnosed and treated for prostate cancer since the trial results were published have gained up to 31,250 extra life years. 

Prostate Cancer UK stated: “The breadth of STAMPEDE and its applicability to everyday practice in the NHS mean that Prostate Cancer UK has been able to use this robust evidence to influence for access to life extending treatments for men that previously had few options available to them.” 

Additional research team members included Dr Claire Vale, Dr Sarah Burdett and Dr Larysa Rydzewska.

Links

• Professor Matt Sydes academic profile 
• Professor Mahesh Parmar academic profile 
• Professor Jayne Tierney academic profile 
• Dr Claire Vale academic profile 
• Dr Sarah Burdett academic profile 
• MRC Clinical Trials Unit at UCL 
• UCL Institute of Clinical Trials and Methodology 
• UCL Faculty of Population Health Sciences 
• UCL Faculty of Population Health Sciences REF 2021

Image 

• Image credit: iStock / Patarapol Prasit