Treatment Options for Advanced Prostate Cancer
- Duran Duran guitarist Andy Taylor, 62, has credited innovative drug Pluvicto for adding five years onto his life amid his battle with metastatic prostate cancer.
- Pluvicto (lutetium Lu 177 vipivotide tetraxetan) was approved by the Food and Drug Administration in March 2022. The drug specifically treats patients with a type of disease called prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC).
- PSMA is a protein expressed in some prostate cancers that can be targeted with medication. Metastatic castration-resistant prostate cancer means the cancer has spread beyond the prostate and does not respond to hormone therapy.
After keeping his disease private for some time, Taylor informed the public last year he had prostate cancera disease that begins in the walnut-shaped prostate gland located between the rectum and bladder. This gland produces the fluid that nourishes sperm.Read More
Taylor said the new treatment was offered to him by Cancer Awareness Trust founder Prof. Sir Chris Evans after he went public with his diagnosis.
He recounted how Evans offered him “a nuclear medicine, Lutetium-177, which is targeted so it only sees cancer cells.”
“It can't see healthy cells. It kills stage four cancer in your bones. And so what it's effectively done is extend my life for five years,” he said, according to BBC News.
“I'm in next week for another round,” Taylor explained, noting that prior to obtaining his new treatment, he was on “the blacklist.”
Getting Back to Work During Treatment
He added, “I had to get in very, very good health to have this treatment. So I really took care of myself in a different way. And then after the first round of treatment, I said, ‘If I'’m OK, and you guys [his doctors] say I'm OK, is it OK to start work again?’
“I don’t want to be a patient stuck here. I want to be a working patient, a little beacon of hope, because this stuff cancer just drags you and your family down in the darkness.”
According to Prof. Evans, Taylor has “stage four prostate cancer with secondary metastases, particularly in the bone tissue,” which means he has limited treatment options. Evans told BBC that the medicines Taylor was on previously were “some of the best medicines available,” but Taylor was “in serious decline.”
Prof. Evans explained, “We took a deep dive into his genetic profile and the specific genomic mutations present in his cancer. We also computed a number of other very specific biochemical and physiological pieces of Andy’s jigsaw. Based on everything we understood, the nuclear medicine Lutetium 177 injections were considered the best option for him.”
He described Taylor to have “done marvelously” on his first round of treatment and his “optimistic” for success on future rounds.
“This may result in quite a substantial life extension for Andy to continue being very creative and active making and performing live music,” Prof. Evans added.
Not only did the new drug add “five years” to his life, it’s also made him feel good enough to create his new solo album dubbed, “Man’s A Wolf To Man.” The album is set to come out next month.
Prior to the album’s release, mxdwn Music received the following statement from Taylor:
“Man's a Wolf to Man is pretty apt now. Having lived there, had kids there, had an amazing career there, I know America very well. And when you watch the breakdown, and the extremes of it, how quickly people became vicious enemies.
“[It's] about how man is his own worst enemy and will behave like a pack of wolves towards his other human enemy. What we saw bubbling when I started writing, it was all about getting even why do you get so mad trying to get even? Why do people get angry? Why don't they just do better themselves?
“I was getting back to making records that are human, about something that mattered or matters, that are in the moment.”
Taylor’s Battle with Prostate Cancer
Andy Taylor shared his prostate cancer diagnosis given his absence from Duran Duran’s Rock and Roll Hall of Fame induction ceremony in Los Angeles in November 2022.
His bandmates read a letter he'd written. In it, the English new wave band’s original guitarist wrote, “Just over four years ago, I was diagnosed with stage 4 metastatic prostate cancer.”
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“Many families have experienced the slow burn of this disease and of course we are no different; so I speak from the perspective of a family man but with profound humility to the band, the greatest fans a group could have and this exceptional accolade,” he said.
Taylor said that his treatment had allowed him “until very recently” to “rock on” and live life somewhat normally.
His letter continued, “Although my current condition is not immediately life-threatening, there is no cure.
“Recently, I was doing OK after some very sophisticated life-extending treatment, that was until a week or so ago when I suffered a setback, and despite the exceptional efforts of my team, I had to be honest in that both physically and mentally, I would be pushing my boundaries.”
Understanding the Life-‘Extending’ Drug
On March 23, 2022, the Food and Drug Administration approved a new drug called Pluvicto (lutetium Lu 177 vipivotide tetraxetan), which specifically treats patients with a type of disease called prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC).
PSMA is a protein that is expressed in some prostate cancers that can be targeted with medication. Metastatic castration-resistant prostate cancer means the cancer has spread beyond the prostate and does not respond to hormone therapy.
This drug may be helpful for anyone with prostate cancer that has spread beyond the prostate and has not responded to hormone therapy.
Pluvicto is a medication that combines diagnostic and therapeutic capabilities. (These medications are often called “theranostics”.) These agents can identify the presence of a target (PSMA) on a patient's cancer cells and then treat it directly, minimizing exposure to normal tissues.
The approval had been lauded as a major win for precision medicine that will expand the possibilities for men with severe disease.
“The approval of lutetium is a major step in the development of personalized treatment for advanced prostate cancer,” Dr. David Penson, of Vanderbilt University Medical Center, told SurvivorNet around the time of the approval.
“This agent specifically targets PSMA-positive metastasis and represents the first theranostic agent for use in castration-resistant metastatic prostate cancer.”
The drug approval was based on the results of a landmark study called the VISION trial and the results of the trial showed:
- That adding the drug to the current standard of care led to a nearly 40% reduction in the risk of death for patients with PSMA-positive mCRPC.
- That adding the drug led to a 60% reduced risk of progression for these same patients.
Dr. Ghassan El-Haddad, associate member of the Diagnostic Imaging and Interventional Radiology Department of Moffitt Cancer Center who oversaw the VISION trial at the cancer center, explained to SurvivorNet that in order to use the drug, patients are first given a PET scan using a special imaging agent which aids in the detection of cancer cells in the body that are PSMA positive.
“The use of Pluvicto is coupled with a PET imaging agent that detects the PSMA-positive metastatic lesions throughout the body,” he said.
“If the patients have PSMA-positive metastatic lesions on PET, then they would be eligible for the therapy. This combination of a (therapy that can deliver radiation to target cells) with an imaging biomarker positivity is a great example of precision medicine or what we call in nuclear medicine, theranostics (therapeutics + diagnostics).”
According to UChicago Medicine, “The idea behind theranostics is to harness the power of radioactivity, which can damage and kill cancer cells without indiscriminately attacking healthy cells in the body. Prostate cancer cells make something on their surface called PSMA prostate specific membrane antigen.
“That PSMA is what the radioactive molecules lutetium-177 PSMA and gallium-68 PSMA attach to. In the case of gallium-68 PSMA, this radiotracer contains a low amount of radiation that lights up the cancer cells on a positron emission tomography (PET) scan so that we can see where the cancer has spread and whether it binds to the radiotracer.
“If the cancer cells do light up, that tells us they will also bind to lutetium-177 PSMA, which contains a similar PSMA tracer but a stronger type of radiation. During treatment, the PSMA grabs on to the lutetium-177 PSMA; the radiation it carries is absorbed into the cancer cell, damaging its DNA and ultimately causing cell death.”
A ‘Major Step’ for Personalized Treatment
Currently, metastatic prostate cancer has a 5-year survival rate of less than 30%, but there is hope that with new targeted therapies which aim to find and destroy cancer cells without killing other cells in the body that rate can be improved. Until this new approval, mCRPC patients who continued to progress, despite different types of therapies, had very limited options.
Dr. Anthony Corcoran, a urologic oncologist at NYU Langone’s Perlmutter Cancer Center, said that the new approval of Pluvicto for men with mCRPC “will revolutionize their treatment as it can target only prostate cancer cells with a radiation emitting molecule. This is precision medicine at its finest and this drug will expand the options for patients with more severe disease.”
There are, however, side effects that may arise when taking this type of medication, with the most common being, fatigue, dry mouth, nausea, anemia, decreased appetite, constipation.
Which Options Are Available for Advanced Disease?
Treatments available to men with advanced prostate cancer vary depending on the person’s current health status, type of disease, and how aggressive the cancer appears. However, other new treatments options such as PARP inhibitors and new androgen depravation drugs have led to a lot of hope in the field.
PARP inhibitors work to stop the activity of poly (ADP-ribose) polymerase, a protein involved in DNA repair. PARP inhibitors prevent DNA from repairing itself in cancer cells, which eventually leads to cell death. Currently, there are two PARP inhibitors available to treat metastatic castration-resistant prostate cancer: Lynparza (olaparib) and Rubraca (rucaparib).
Hormone therapies may also be used to manage advanced prostate cancer to prevent it from growing and spreading further. Androgen deprivation therapy is a type of hormone therapy that works by inhibiting androgen production, including testosterone, or blocking androgen receptors which can slow tumor growth.
Two newer androgen deprivation therapies for late-stage prostate cancer include Xtandi (enzalutamide) and Erleada (apalutamide). You can read more about treatment for advanced prostate cancer here.
Contributing: SurvivorNet Staff