I was diagnosed with locally advanced prostate cancer in July, 2015. Very High Risk: PSA - 26, Gleason 4 +4 = 8, T3b N1M0.
I was admitted to the STAMPEDE trial and was randomised to the control Arm, Arm A which was ADT + RT. I had hoped I would have been randomised to Arm J which is Arm A+arbiraterone+enzalutamide. No luck.
Post RT, in May 2016, my PSA was 0.14 but it has risen on 5 consecutive blood tests to 1.4 in the past 12 months. My doubling time is 3.16 months. If this trend continues, I would expect to exceed the Nadir +2 =2.14 in August and the STAMPEDE definition of biochemical failure, which in my case would be >5, some time in November 2017. I don't know if I have any metastases.
I saw my oncologist on the Tuesday before the Arbiraterone paper was published. I was unaware of it's imminent publication but my oncologist told me it would be published at the weekend. Naively, I asked if I would be placed on Arbiraterone once I had been deemed to be castrate resistant i.e. I had experienced biochemical failure. Had I known the results that have since been published, the question would have been, "Can I start arbiraterone treatment NOW, please?"
Unfortunately, the answer would have been the same.
In Scotland and the rest of the UK, Arbiraterone is only given as front line medication with HT to patients who are metastatic.
For it to be made available to nmCRPC patients, I was told that the following needs to happen:-
- the drug company will need to approve it for that use and this could take 6 - 9 months
- the Scottish Medicines Consortium will need to approve it
- the money needs to be found to pay for this (and it will be expensive). It will need to be balanced with other NHS costs/ benefits across the board.
Also, it will take 2 years before Arbiraterone can become a generic drug and this will drive down the cost.
Here's what the Independent had to say about the news:
"Around 20,000 men a year with prostate cancer could benefit from a combination of drugs that boost survival dramatically, experts say.
A clinical trial run by Cancer Research UK – believed to be the biggest cancer treatment trial in the world – has found that giving two therapies at once cuts disease progression and offers some patients the chance of a cure.
Researchers say the new drug regime could “transform the treatment” of 20,000 men newly diagnosed with the disease each year in England.
Of these, 5,000 men with the most advanced disease which has spread around the body could see their life expectancy jump from 3.5 years to seven years on average.
Of the 15,000 diagnosed when the disease is confined to the pelvic area, most could expect to live as long as they would if they were cancer-free.
The study, presented at the American Society of Clinical Oncology (ASCO) meeting in Chicago, included around 1,900 men with locally-advanced cancer or whose disease had already spread."
http://www.independent.co.uk/news/health/hope-for-20000-prostate-cancer-patients-after-worlds-biggest-treatment-trial-a7770871.html
Here's are two quotes from the Guardian article:
“Abiraterone not only prolonged life, but also lowered the chance of relapse by 70% and reduced the chance of serious bone complications by 50%,” James said. “Based on the magnitude of clinical benefit, we believe the upfront care for patients newly diagnosed with advanced prostate cancer should change.”
“The potential benefits of giving some men abiraterone alongside hormone therapy are clearly impressive and we will be working with all relevant bodies to make sure this treatment becomes an option available for these men via the NHS,” said Dr Iain Frame, director of research at Prostate Cancer UK."
For many of us, the arbiraterone treatment will come too late and will be used in a palliative setting rather than a treatment to extend our lives and lower the chance of relapse and serious bone complications.
It would be a goodwill gesture from Janssen, the drug manufacturer to waive the cost of their drug, ZYTIGA® (abiraterone acetate) in the case of people who have participated in clinical trials but who were randomised to the Control Arm of the trial. Our hopes were raised when we entered the STAMPEDE trial and we are proud to have been part of a trial which has yielded such positive results and which will benefit 1,000's of men in future. Is it too much to ask if we can have arbiraterone now and not wait until our disease has progressed?