AI to help end ‘postcode lottery' for vital prostate cancer drug
A study has discovered that the technology can identify the patients who will benefit most from a "game changer" drug.
Abiraterone, a hormone therapy that blocks testosterone production to prevent the growth of prostate cancer, is approved for NHS use in England for patients with advanced prostate cancer that has spread.
However, it is not approved for men newly diagnosed with high-risk prostate cancer that has not yet spread, even though it has been available for these patients in Scotland and Wales for the past two years.
The new test, developed by Artera, uses AI to detect features invisible to the human eye on images of tumour samples.
The study, led by The Institute of Cancer Research, London, and University College London (UCL), ran the test on biopsy images from more than 1,000 men who took part in the Stampede trial.
Patients were given a score of either biomarker-positive or biomarker-negative.
Researchers found abiraterone reduced the risk of death among biomarker-positive patients from 17 per cent to 9 per cent.
In biomarker-negative patients, the drug cut death risk from 7 per cent to 4 per cent, with researchers suggesting this indicates these men would benefit from standard therapy.
Nick James, a professor of prostate and bladder cancer research at The Institute of Cancer Research, London, and consultant clinical oncologist at The Royal Marsden NHS Foundation Trust, is chief investigator of Stampede and co-led the new study.
He said: 'This research shows that we can pick out the people who will respond best to abiraterone, and those who will do well from standard treatment alone – hormone therapy and radiotherapy.
'Access to this life-extending drug is currently a postcode lottery – with those living in Scotland and Wales able to receive the treatment for free.
'The NHS in England has previously decided that it would be too expensive to offer the drug. Since the patent expired in 2022, abiraterone costs just £77 per pack – compared with the thousands of pounds that new drugs cost.
'Previous research by my team has shown that preventing cancer relapses for these men would save more money than the drug costs to purchase.
'I truly hope that this new research – showing precisely who needs the drug to live well for longer – will lead to NHS England reviewing their decision not to fund abiraterone for high-risk prostate cancer that has not spread.'
Prof James also highlighted that while abiraterone can have 'spectacular' results, it does have side effects.
'Abiraterone has already hugely improved the outlook for hundreds of thousands of men with advanced prostate cancer,' he said.
'We know that for many men with cancer that has not yet spread, it can also have spectacular results.
'But it does come with side effects and requires additional monitoring for potential issues with high blood pressure or liver abnormalities.
'It can also slightly increase the risk of diabetes and heart attacks, so knowing who is most likely to benefit is very valuable.'
Experts hope the findings, presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, may lead to a change in the availability of abiraterone in England.
Prof Kristian Helin, chief executive of The Institute of Cancer Research, said the drug has been a 'game changer for treatment of prostate cancer'.
'Alongside our mission to find smarter, kinder treatments, we must ensure we are matching the right drugs to the right patients,' he added.
'This research, using artificial intelligence, provides an innovative route to testing prostate cancer patients to determine their treatment.
'I hope that this can be implemented so that all men with prostate cancer who will benefit from abiraterone can do so.'
Dr Matthew Hobbs, director of research at Prostate Cancer UK, said: 'Prostate Cancer UK has been calling on the UK Government to approve this life-saving, cost-effective drug for over two years.
'These exciting results suggest a way to make this an even more cost-effective approach.
'We therefore echo the researchers' urgent call for abiraterone to be made available to those men whose lives it can save – men who, thanks to this research, we can now identify more precisely than ever before.'
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