ASCO 2018 - Keytruda: -Patrick forbes... - Advanced Prostate...

Advanced Prostate Cancer

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ASCO 2018 - Keytruda

pjoshea13 profile image
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-Patrick

forbes.com/sites/victoriafo...

The first major clinical trial to test immunotherapy in men with advanced prostate cancer has shown promising results, albeit in a small percentage of patients.

The research was led by scientists at the Institute for Cancer Research and Royal Marsden Hospital, both in London, UK and is being presented this weekend at the American Society of Clinical Oncology Meeting in Chicago.

The trial featured 258 men treated with the immunotherapy agent pembrolizumab (marketed by Merck as Keytruda), with 38% being alive after a year and 11% who have had no cancer growth at all since the trial began.

"We were working with very late-stage patients who had progressed even after every other type of treatment. Ten to fifteen percent of men did spectacularly well," said Professor Johann de Bono, Director of the Drug Development Unit at the Institute of Cancer Research.

However what is perhaps even more interesting than the 11% of men who had substantial responses, is the researchers have reason to believe that many of these tumors may have mutations in genes which control vital cellular processes that maintain the genome, called DNA repair.

When functional, DNA repair works constantly in every cell to fix damage done to DNA, much of which occurs naturally every time the cell divides. The amount of this damage a cell endures can, however, be greatly exacerbated by external factors such as smoking, alcohol and exposure to UV light, and perhaps unsurprisingly many cancer cells have lost some of this ability to self-repair the genome.

“As with many other cancer types, many people don't benefit. We have evidence that people with DNA repair mutations do respond to the treatment, but more work is needed to confirm this," said de Bono.

This is partly underpinned by other trials showing that DNA repair deficient tumors of different types, for example, bowel cancers do respond well to immunotherapy. In addition, de Bono and colleagues will be publishing more research over the coming months which provides evidence for this link between DNA repair deficient tumors and response to pembrolizumab.

Prostate cancer can be treated in a number of ways, but some of the more extreme treatments include surgical interventions, which can cause a range of physical and psychological side effects for patients. If the patients who respond to immunotherapy can be identified, it may lead to the avoidance of these treatments for at least some men with prostate cancer.

"The drug was extremely well tolerated by our patients. If we can find out who will respond upfront, we may be able to avoid treatments such as castration for some patients," said de Bono.

All is not lost for people who don't currently respond to immunotherapy alone though. The researchers are currently running an additional clinical trial to test pembrolizumab in combination with drugs such as PARP inhibitors, which target DNA repair processes and speculatively may to some extent mimic the response to immunotherapy of those with DNA repair mutated tumors.

Prostate cancer is the third most common type of cancer in the U.S., with 164,690 men diagnosed every year. Considering the large numbers of people affected, if immunotherapy proves to be a suitable treatment for 10-15% of men with prostate cancer, it represents a significant step forward and the low toxicity gives hope that more drastic procedures may be avoidable at least for some patients if the further work to identify who will respond and who won't is successful.

"It’s exciting that immunotherapy could offer some men more time with their loved ones where they have such advanced disease that they have run out of existing treatment options," said de Bono.

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AlanMeyer profile image
AlanMeyer

I think this is a very encouraging report. I'm always particularly encouraged by reports of treatments that work well in men who have failed ADT and chemotherapy, the two most common treatments.

Thank you for posting it.

Alan

rococo profile image
rococo

Keytruda now being used off lable in many places. Rocco

ronnie1943 profile image
ronnie1943

Hi, My husband Sam's oncologist was hoping for Keytruda for him after chemo,etc failed. Biopsy showed Sam was not a canadate for Keytruda, however he did have mutations for a targated therapy drug which he is on now, the side effects are pretty rough, hoping as time goes on they will subside some???

wifeofvet profile image
wifeofvet

well, my husband developed a second cancer during the course of his 13 year battle with aggressive prostate cancer and the treatment was Keytruda. he still coursed through his hormone ablation meds in exactly the time frame that those NOT ON KEYTRUDA seem to do. he failed them all...casodex, zytiga, and xtandi along with lupron the whole time. beware.

wifeofvet profile image
wifeofvet in reply towifeofvet

the keytruda did nothing for his prostate cancer, in other words.

j-o-h-n profile image
j-o-h-n

As I said before Keytruda is a God sent for my Lung melanoma.

Good Luck and Good Health.

j-o-h-n Monday 06/04/2018 5:01 PM EDT

paulofaus profile image
paulofaus

I had Keytruda, in 2016 as an adjunct to cryo. Doesn't seem to have helped in my case.

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