Genetic key to prostate cancer
Our study shines new light on the genetic complexity of prostate cancer as it develops and spreads – revealing it to be not a single disease, but many diseases each driven by their own set of mutations.
Thousands of men with prostate cancer could be treated with drugs developed for other tumours, according to an ‘‘incredibly exciting’’ study that reshapes understanding of the disease.
Ninety per cent of men with advanced cancer have genetic mutations that could be targeted with drugs designed to treat other types of disease, suggest ‘‘gamechanging’’ findings by British researchers.
They say that the discovery could offer patients dozens of new therapies.
The findings move the United Kingdom’s National Health Service a step closer to routine DNA analysis of tumours to discover which drugs are likely to be most effective, as treatment becomes increasingly personalised by genetic type.
Scientists gathered samples from 150 patients of tumours that had spread to the bone, lymph nodes and soft tissues, before analysing their genetic code as well as those of the patients.
Writing in the journal Cell, they say that the ‘‘comprehensive genetic map’’ of prostate cancer that results shows that 89 per cent of men have targetable mutations.
Johann de Bono, of the Institute of Cancer Research in London, who led the research, said: ‘‘Our study shines new light on the genetic complexity of prostate cancer as it develops and spreads – revealing it to be not a single disease, but many diseases each driven by their own set of mutations.’’
He said the findings could be ‘‘game-changing’’, arguing: ‘‘What’s hugely encouraging is that many of the key mutations we have identified are ones targeted by existing cancer drugs, meaning that we could be entering a new era of personalised cancer treatment.’’
For example, a fifth of the men had mutations in the BRCA genes, which increase the risk of breast cancer, as in the case of the actress Angelina Jolie.
Trials are under way to test whether drugs designed to target these mutations will help men with prostate cancer, and de Bono said that similar work must now be done for therapies.
He said that this meant there are ‘‘certainly more than 10 and hopefully in the future it will be more than 100’’ new drugs that could be used in prostate cancer.
‘‘There have only been five or
a
string
of
other six drugs that have ever improved survival so if we get 10 more in the next decade that would be amazing,’’ he said.
Every year 42,000 men in the UK are given a diagnosis of prostate cancer, a fifth at the most advanced stage when the disease has spread.
De Bono said that a wider range of drugs could help more men to survive the disease, which kills 11,000 a year.
He already routinely does genetic profiles of his patients at the Royal Marsden hospital in London and says that with the cost down to about £300 (NZ$0), this should spread throughout Britain in less than five years.
‘‘It’s not yet rolled out across the NHS but it soon will be. I have no doubt that in the very near future it will become the standard of care,’’ he said. ‘‘It will bring a huge opportunity for bringing lots of drugs in to these patients and treating them more precisely and better.’’
Iain Frame, director of research at Prostate Cancer UK, said: ‘‘This is incredibly exciting and groundbreaking research. It suggests for the first time the list of genetic mutations to search for to build up a blueprint of a man’s prostate cancer once it has spread. This could provide the information about the best routes of attack in each individual case, which is crucial if we are to reduce the number of men dying needlessly from this disease.’’
Paul Workman, chief executive of the ICR, said: ‘‘Cancer becomes lethal at the stage when it spreads round the body and stops responding to treatment but until now it has been incredibly difficult to find out exactly what is going on genetically at that critical point.
‘‘This major new study opens up the black box of metastatic cancer, and has found inside a wealth of genetic information that I believe will change the way we think about and treat advanced disease.’’
Johann de Bono