The latest treatments for prostate cancer with lymph and bone metastases [2024]

Prostate cancer is common among men. Many cases progress to an advanced stage where the cancer spreads beyond the prostate, often to the bones and lymph nodes. This metastatic stage presents significant challenges. It can lead to severe complications such as bone pain, fractures, and lymphatic obstruction.

Recent advancements in metastatic prostate cancer treatment offer new hope for patients.

In this article, we'll explore the latest therapies targeting bone and lymph node metastases. Including androgen deprivation therapy, targeted therapy, and immunotherapy. You'll also learn where they're approved and how you can access them quickly.

Latest treatments for prostate cancer with bone and lymph metastases

In cases of bone metastasis from advanced prostatic cancer, initial treatment typically includes androgen deprivation therapy (AD). Immunotherapy and targeted therapy have also emerged as new treatment options in recent years.

Androgen deprivation therapy (ADT)

While ADT is not a new approach, there are innovations within it, including:

• Gonadotropin-releasing hormone (GnRH) agonists. These types of medicines temporarily stop the production of male hormones (androgens). As a result, cancer cells are starved and the prostate shrinks.

  
  One of the latest approved GnRH agonists is Camcevi (leuprolide mesylate). It got FDA approval in 2021 and EMA approval in 2022 ^1,2. Camcevi is similar to Eligard, but is easier to administer, as it does not require pre-mixing.

   

• Gonadotropin-releasing hormone (GnRH) antagonists. These types of medicines act similarly to GnRH agonists, but are quicker to act. They may be more relevant when the disease is quickly progressing.

  One of the latest approved GnRH antagonists is Orgovyx (relugolix). It's been approved in the USA since 2020, and in the EU - since 2022 ^3,4. It's available as pills, which may make it more convenient than other GnRH antagonists, which are administered as an injection.

   

• Combined androgen blockade. Some doctors recommend a combination of GnRH agonists with a so-called "antiandrogen" for at least a short period of time.

  The latest approved antiandrogens are Xtandi (enzalutamide) and Nubeqa (darolutamide). Both are approved in the USA, EU, and a number of additional countries around the world ^5,6,7,8.

Targeted therapy

Targeted therapy is a novel approach to treating metastatic prostate cancer. It is only applicable to a small subset of prostate cancer patients, where the cancer has a specific genetic mutation.

Examples of the latest approved targeted therapies for advanced prostate cancer are:

• Lynparza (olaparib). This PARP inhibitor is designed specifically for prostate cancer with the BRCA1/2 mutations. The medicine has been approved in the USA for over a decade, but its prostate cancer indication was added in 2020. Lynparza is also EMA approved, and since 2023 - also for prostate cancer ^9,10.
• Akeega (niraparib / abiraterone acetate). This medicine combines PARP inhibition with a novel hormonal therapy. It's designed specifically for patients with metastatic castration-resistant prostate cancer, where the BRCA 1/2 mutations are present. Akeega is used alongside prednisolone. As of July 2024, it's approved by the FDA and EMA ^11,12.
• Enhertu (fam-trastuzumab deruxtecan-nxki). This antibody-drug conjugate is designed for solid cancers (including prostate cancer) which overexpress the HER2 protein. Enhertu combines trastuzumab, an anti-HER2 antibody, with a chemotherapy substance, delivering the chemotherapy directly to the cancer cells. This approach enhances the medicine's effectiveness while minimizing systemic exposure. Enhertu has only recently been approved for use in HER2-positive solid cancers, and as of July 2024, it's only approved in the USA for this indication ¹³.
• Pluvicto (lutetium Lu 177 vipivotide tetraxetan). This radioligand therapy is specifically designed for metastatic prostate cancer that is PSMA (prostate-specific membrane antigen) positive. Pluvicto is approved for use in combination with ADT with or without androgen receptor (AR) pathway inhibition. As of July 2024, Pluvicto is approved in the USA and EU ^14,15.

Immunotherapy

In recent years, immunotherapy has started to play a larger role in cancer treatment. Immunotherapy harnesses the body's own immune system in order to fight cancer. Unlike traditional treatments which target cancer cells directly, immunotherapy aims to boost the immune system's ability to recognize and attack cancer cells.

The latest immunotherapy approvals for metastatic prostate cancer include:

• Keytruda (pembrolizumab): This medicine can be used across a variety of cancer types. Keytruda works by blocking the PD-1 receptor. This receptor can combine with a protein called PD-L1 and prevent the immune system from attacking cancer cells. By blocking PD-1, Keytruda increases the immune system's ability to kill cancer cells.

   As of July 2024, Keytruda is only approved in the USA for use in solid tumors (including prostate cancer) ¹⁶.

Emerging therapies and treatments

A lot is going on in the field of prostate cancer treatment. While development and approval can take some time, there are a number of treatments currently being studied, which can further expand the options of prostate cancer patients.

Just one example are AKT inhibitors such as Truqap (capivasertib). Truqap is currently only approved for HR-positive, HER2-negative locally advanced or metastatic breast cancer. However, a phase 3 clinical trial is ongoing to study its efficacy in HR-sensitive prostate cancer and metastatic castration-resistant prostate cancer. The final study results are expected in 2026 ¹⁷.

What if a novel treatment is not available in your country yet?

As new prostate cancer treatments are developed, approval can take years in some countries. Unfortunately, this delay can come at a high price for prostate cancer patients. However, waiting is not your only option. If a treatment is already approved somewhere in the world, you can already access it now.

This is possible thanks to the Named Patient Import regulation in effect in most countries.

Is one of the latest prostate cancer treatments not (yet) approved in your country? We can help you access it legally if you have a prescription from your doctor. Contact us to find out more.

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References:

1. CAMCEVI® (leuprolide) 42mg injection emulsion, FDA Approved for Treatment of Advanced Prostate Cancer, Available Exclusively at Biologics by McKesson. McKesson, 19 June 2024.
2. Camcevi | European Medicines Agency. European Medicines Agency, Accessed 23 July 2024.
3. Orgovyx | European Medicines Agency. European Medicines Agency, Accessed 23 July 2024.
4. FDA approves relugolix for advanced prostate cancer. FDA, 18 December 2020.
5. Xtandi | European Medicines Agency. European Medicines Agency, Accessed 23 July 2024.
6. Nubeqa, INN-darolutamide. European Medicines Agency, Accessed 23 July 2024.
7. FDA approves enzalutamide for non-metastatic castration-sensitive prostate cancer with biochemical recurrence. FDA, 17 November 2023.
8. FDA approves darolutamide tablets for metastatic hormone-sensitive pro. FDA, 5 August 2022.
9. Lynparza | European Medicines Agency. European Medicines Agency, Accessed 23 July 2024.
10. FDA D.I.S.C.O. Burst Edition: FDA approval of Lynparza (olaparib), with abiraterone and prednisone, for BRCA-mutated metastatic castration-resistant prostate cancer. FDA, 13 July 2023.
11. FDA approves niraparib and abiraterone acetate plus prednisone for BRC. FDA, 11 August 2023.
12. Akeega | European Medicines Agency. European Medicines Agency, 2 June 2023.
13. FDA D.I.S.C.O. Burst Edition: FDA approval of Enhertu (fam-trastuzumab deruxtecan-nxki) for unresectable or metastatic HER2-positive solid tumors. FDA, 26 April 2024.
14. FDA Approval Summary: Lutetium Lu 177 Vipivotide Tetraxetan for Patients with Metastatic Castration-Resistant Prostate Cancer. Clinical Cancer Research, 1 May 2023.
15. Novartis receives European Commission approval for Pluvicto® as the first targeted radioligand therapy for treatment of progressive PSMA–positive metastatic castration-resistant prostate cancer. Novartis, 13 December 2022.
16. Rosa, Kristi. FDA Grants Full Approval to Pembrolizumab for Select Patients With MSI-H or dMMR Solid Tumors. OncLive, 29 March 2023.
17. Study of Capivasertib + Docetaxel vs Placebo + Docetaxel as Treatment for Metastatic Castration Resistant Prostate Cancer (mCRPC) (CAPItello280). ClinicalTrials.gov, Accessed 23 July 2024.