STOPCAP study finds that most men with advanced prostate cancer benefit from new-generation hormone therapy drugs
13 Feb 2025
Most men with advanced prostate cancer benefit from the new-generation drugs which target the androgen receptor (ARPIs). This is according to new results from a meta-analysis by the STOPCAP Collaboration. Younger patients who are still responding to standard hormone therapy seem to benefit from the addition of these drugs, but older patients may benefit from some of them more than others.
The results were presented today at the American Society of Clinical Oncology Genitourinary (ASCO GU) Meeting in San Francisco, USA.
The STOPCAP meta-analysis investigated the effects of three drugs within the androgen receptor pathway inhibitor class (ARPIs): enzalutamide, apalutamide and abiraterone. These drugs work by preventing testosterone and other androgen hormones from attaching to androgen receptors on prostate cancer cells. This interrupts prostate cancer growth.
The study showed that for men younger than 75 years old, adding enzalutamide, apalutamide or abiraterone to standard hormone therapy delayed the disease progressing and improved survival. After five years, around 60% of men who received these drugs were alive, compared with 44% who had hormone therapy alone.
For men aged 75 years or older, the “amide” drugs, enzalutamide and apalutamide, delayed disease progression and improved how long patients live by a similar amount. In this older age group, abiraterone also delayed disease progression and reduced deaths from prostate cancer. However, abiraterone did not seem to increase the overall proportion of men alive after five years.
No other characteristics of the patients or their prostate cancer appeared to influence the effects of these drugs.
These results confirm that drugs targeting the androgen receptor substantially prolong the lives of most men with advanced prostate cancer. Reassuringly, younger men benefit from all three drugs explored. Clinicians and patients need to weigh up the risks and benefits of abiraterone and “amides” for older men. The team say that further research is needed to understand the apparent difference in the effect of abiraterone in the older age group.
The meta-analysis included data from 7,778 individuals across seven clinical trials. This accounts for 100% of participants from relevant abiraterone trials, but only 48% of data from amide trials. By combining individual participant data from multiple trials, the team could explore the effects of ARPI drugs in more detail and more reliably than in previous studies.
The next step for the team is to obtain data from more ARPI trials to better understand the effects of these drugs. They will also investigate how ARPIs compare with other standard treatments for advanced prostate cancer, such as docetaxel chemotherapy and radiotherapy directed at the prostate, and which patients might benefit from a combination of these treatments.
This international research project was led by the MRC Clinical Trials Unit at UCL on behalf of the STOPCAP Collaboration, and funded by the UKRI Medical Research Council and Prostate Cancer UK.
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