Improving treatment and quality of life for patients with Prostate Cancer

Prostate cancer affects 1 in 9 men in the UK, approximately 25% of whom will die from metastatic prostate cancer. Research from Queen’s University Belfast has meant that patients can benefit from participation in clinical trials. Those not involved in trials have benefitted from access to treatments that were not available as part of standard care. The research has also influenced clinical guidelines (locally and globally) and resulted in commercial impact through the development of Ra-223 treatment (Xofigo®).

Research Challenge

Achieving better clinical outcomes for prostate cancer patients

Prostate cancer is now the most commonly diagnosed malignancy in the UK; 40,000 new cases and nearly 12,000 deaths estimated per year. In Northern Ireland there are approximately 1,200 cases of prostate cancer diagnosed annually, of which 25% will die of metastatic disease. In response to this, academics at Queen’s University Belfast established the Advanced Radiotherapy Group (ARG). This multidisciplinary group aims to improve clinical outcomes for patients and is embedded in the Northern Ireland Cancer Centre. The Group focusses on clinical trials of novel therapeutics in metastatic castration-resistant prostate cancer, and its precursor, metastatic hormone sensitive prostate cancer, as well as advanced radiotherapy in localised prostate cancer.

Our Approach

A Multidisciplinary Approach to patient treatment

Radium-223 (Xofigo®)

THE novel alpha radionuclide treatment, Ra-223, is a “calcium mimetic” that, like calcium, accumulates preferentially in areas of bone that are undergoing increased turnover. The alpha particles have a narrow emission range compared to beta particles, limiting damage to surrounding healthy tissues.

The phase 3 ALSYMPCA trial demonstrated improved overall survival compared with placebo regardless of previous docetaxel-based chemotherapy usE. This was the first radionuclide therapy to demonstrate survival benefit in a metastatic cancer of any type.

Clinical Trials of External Beam Radiotherapy

The ARG have made significant contributions to the development of radiotherapy technologies which have facilitated early adoption in the NHS in Northern Ireland, resulting in improved cure rates, reduced toxicity, and increased efficiency of radical radiotherapy.

CHHiP and CHHiP-IGRT Trials demonstrated equivalence of Hypofractionated radiotherapy (the delivery of fewer, larger doses of radiotherapy and for improving dose intensity) in localised prostate cancer using Intensity Modulated radiotherapy, IMRT (high-precision radiotherapy that uses computer-controlled linear accelerators to deliver precise radiation doses to specific areas within the tumour) and Image-Guided Radiotherapy, IGRT (use of imaging during radiation therapy to improve the precision and accuracy of treatment delivery).

The ‘SPORT trial’ was the first if its kind in the UK to use ‘SABR’ (Stereotactic Ablative Body Radiotherapy) to target tumours and deliver large doses per treatment, providing an opportunity for dose escalation beyond that achievable with conventional radiotherapy and allowing men to have their full course of radiotherapy in only 5 hospital visits instead of the typical 37. In addition, patients in the study were treated with SpaceOAR, a minimally invasive hydrogel technology, inserted prior to radiotherapy treatment which has been shown to significantly decrease unwanted radiotherapy side effects for patients.

“If it wasn’t for this research, I simply would not be here. My family and I are so thankful to the doctors who have helped us. This treatment has allowed me to live my life again."

What impact did it make?

Prolonged overall survival and improved quality of life

Research at Queen’s University Belfast has led and contributed to a number of impacts, not least, playing a major role in the registration trial for the first FDA-approved alpha particle Radium-223 (Xofigo ®), resulting in prolonged overall survival and improved quality of life for men with metastatic castration resistant prostate cancer, providing access for prostate cancer patients to advanced radiotherapies and subsequent introduction as standard care to the Northern Ireland Health Service and Influencing treatment guidelines across Europe.

Radiotherapies that have been introduced as a result of clinical trials include Intensity Modulated Radiotherapy (IMRT) and Image-guided radiotherapy (IGRT). Ra-223 was licensed in 2014 and NICE approved in 2016. Numbers decreased as a result of new toxicity data from ERA-223 trial in 2018. At the peak, almost 300 treatments per year were administered in Belfast. There has been steady increase in the use of this technology over the past decade, increasing from 375 patients in 2013 to 2,389 in 2020. Now patients with multiple tumour types benefit from this therapy.

Skills gained in delivery of clinical trials have built capacity of local healthcare staff and encouraged the adoption of the cutting-edge techniques into routine practice. For example, Stereotactic Ablative Body Radiotherapy (SABR), an external beam radiotherapy which provides better tumour targeting, was introduced as the first of its kind in the UK and led to 14 therapeutic radiographers being trained in the technique.

Patients have also benefitted from early access to advance radiotherapy treatments introduced as a result of trials. For example, as a result of the CHHiP trial which tested hypofractionated radiotherapy there are now new recommendations for a new standard of care for men with prostate cancer. Men now receive fewer treatments with the same results, leading to less disruption to their lives, including a reduction in hospital visits, with an average saving of 17 visits per patient. It is estimated that this will save the NHS in England at least £8,000,000 per year.