Doctors call them “super drugs”: they are a new class of anticancer agents that have been shown to be effective against some cases of advanced prostate cancer, when metastases are already present. The medicines in question are “Parp inhibitors”. They have been shown to be effective in metastatic prostate cancer, which no longer responds to treatments, and in the presence of specific mutations in the tumor’s DNA, such as those of the BRCA1 and BRCA2 genes. Today, the Italian urologists of the Italian Society of Urology (Siu), at a conference in Riccione, are discussing this promising new path.
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The Achilles heel of cancer
Prostate cancer is the most common malignancy in the male population and accounts for 20% of all cancers aged 50 and over. Genomics today makes it possible to find new weapons to combat this disease and improve the lives of patients. The idea is to study the characteristics of cancer to find the Achilles heel to target. Drugs that inhibit Parp also do this, where Parp is a family of proteins involved in various biological processes, including the repair of tissue DNA. In some cases of advanced prostate cancer, the Parp protein, along with the BRCA2 gene (but BRCA1 also plays a role), helps repair damage to the cancer tissue’s DNA and allows diseased cells to sustain themselves and survive. “Identifying alterations in the BRCA2 and BRCA1 genes,” he points out Francesco Porpiglia, Professor of Urology at the University of Turin and head of the Siu scientific office, “it is essential in advanced forms, to identify patients who could benefit from Parp inhibitors”. Parp inhibitors are effective both in the case in which the mutations are germline (or germinal), which can be transmitted by inheritance, and the somatic ones, which occur in any cell of the body and are not hereditary.
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An effective treatment
Parp inhibitors include the drug oloparib, already authorized by the Food and Drug Administration (Fda) in the United States, together with rucaparib. Oloparib has also received approval from the European Medicines Agency (Ema), but in Italy administration is still not possible, except within specific clinical trials – in which in some cases patients can take part. . Taking the efficacy results in hand, in the phase 3 clinical trial (the last stage of the trial), called Profound, treatment with oloparib in participants with metastatic and resistant prostate cancer, in the presence of the aforementioned mutations, doubled the survival time “free from disease progression” (ie in which the tumor does not advance). “The results are significant”, underlines Giuseppe Carrieri, director of the department of Urology at the University of Foggia, “and we are increasingly moving towards the goal of making the disease chronic, with patients suffering from cancer in the metastic phase surviving in some cases even for several years “.
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Experts agree that this is one of the main promising avenues that could soon become a reality for many patients. “If everything goes as we hope – adds Carrieri – the drug could arrive within a year or a year and a half”. In short, to date, given that in Italy there is still no official go-ahead, the treatment is not yet accessible to everyone. “The central point – continues Porpiglia – is and will be to make these genetic tests increasingly available to candidates with metastatic and therapy-resistant cancer. Recalling that there are not a few. In Italy about 20 thousand patients have resistance to hormonal therapy: between these on average in 3 thousand patients could present the mutations. And still in 50% of these people could have an optimal response to treatment “.
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by Irma D’Aria
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