Urology Awareness Month: can a new hormone-blocking drug help prostate cancer?

Dr Valentine Macaulay is a Medical Oncologist in the Nuffield Department of Surgical Sciences, University of Oxford. Her research team is investigating how a hormone called insulin-like growth factor (IGF) affects prostate cancer.

Men with high levels of IGF in their blood have an increased risk of developing prostate cancer. IGF is required for normal development but also helps cancer cells grow and spread. It is not known exactly how IGF affects prostate cancer risk, but research suggests it may affect the cancer cells themselves and the surrounding non-cancerous supporting cells, which could allow small cancers to escape detection by the immune system.

At the Churchill Hospital, Oxford we are conducting a clinical trial called WINGMEN: Windows study of INsulin-like Growth factor blockade in MEN scheduled for radical prostatectomy. The trial is funded by Prostate Cancer UK and sponsored by the University of Oxford. The trial will show us what changes in the tumour and blood after IGF blocker treatment and whether the treatment reduces signs of tumour growth.

We are recruiting men with localised prostate cancer (with no evidence of spread) who have been offered an operation to remove the prostate, called a prostatectomy. Most men have to wait four to five weeks between a decision to have surgery and actually having the operation. In this window, trial participants will be given treatment with new IGF blocker drug xentuzumab, developed by pharmaceutical company Boehringer Ingelheim. Xentuzumab has been tested in patients with advanced cancer and is generally well-tolerated, although it can cause side-effects including fatigue.

To be eligible for the trial, men must be fit for surgery and not diabetic or on hormone therapy. Participants will be given xentuzumab through a needle (drip) inserted into a vein, weekly for four weeks. We arrange trial visits around patients’ commitments and without delaying surgery. Blood and tissue samples are gathered before and after completing the four treatments. We use the routine prostate biopsy as the pre-treatment tissue sample and the prostatectomy as the post-treatment tissue sample. No additional biopsy is needed.

The blood and tissue samples will be compared to measure how effectively xentuzumab reduces signs of tumour growth and identify which genes and proteins are affected by the drug. This information may help researchers improve treatment of men with prostate cancer, with the long-term aim of reducing the risk of aggressive prostate cancer.

Contact Dr Valentine Macaulay for more information at valentine.macaulay@nds.ox.ac.uk