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Prostate cancer – Vienna as international centre

(Vienna, 29 March 2010) Currently as many as three clinical trials to treat prostate cancer are ongoing at the Vienna General Hospital AKH. These explore three alternative treatment approaches towards the hormone refractory prostate carcinoma: an innovative immunotherapy, a novel way of hormone therapy and the supplement to current standard therapy. This means that a comprehensive range of treatments for this form of prostate cancer, which has been difficult to treat to date, is being evaluated centrally at the Department of Medicine I of MedUni at AKH. The possibility of Austrian patients taking part in clinically controlled trials on as many as three of the most modern forms of therapy is attracting international attention.

Intense efforts to heal patients combined with intensive research activities characterise the working group on urological tumours at the Department of Medicine I of the Vienna General Hospital. A commitment that is now bearing fruit: the group is currently a sought-after partner for international colleagues in three clinical trials on the hormone refractory prostate carcinoma.

But for the head of the working group Prof. Dr. Michael Krainer this large number of studies is mainly a sign of the extensive progress it has been possible to achieve in recent years in the development of medication against prostate cancer: "In case of early diagnosis, surgical intervention still represents the optimal therapy form. Should the tumour return in later years, however, or if it was diagnosed only at a late stage, our treatment options were very restricted until recently. But the intensive research activities by many working groups across the globe have led to real progress in recent years. We are satisfied as well as a bit proud that we are at the forefront not only in relevant fundamental research but also in clinical trials of numerous applications."

In particular, the team headed by Prof. Krainer focuses on the treatment of those recurrent tumours that do not (or no longer) respond to the currently selected therapy – the withdrawal of androgenic hormones. Particularly for these tumours that are termed "hormone refractory prostate carcinoma" (HRPC), the new therapies offer real alternative treatments or supplements to the previous therapeutic of choice, docetaxel.

3 therapeutic approaches, 3 trials, 3 times Vienna

The group around Prof. Krainer has recently been asked a total of three times to take part in trials to test new therapeutics. They pursue three different therapeutic approaches, all of which have good chances of treatment success. As well as innovative immunotherapy, a novel way of hormone therapy is also being examined. But the supplement to standard therapy also offers interesting opportunities, which are being evaluated by Prof. Krainer and his team.

Since October 2009, within the framework of immunotherapy, the use of a so-called "monoclonal" antibody has been examined that is able to activate the body's own immune system against tumour cells. Explains Prof. Krainer: "The antibody termed ipilimumab led to very surprising successes last year within the framework of a small-scale study as an alternative to docetaxel. In three patients, these tumours, which previously had been difficult to treat, became so small that they could be removed surgically. As a small-scale study like this one is indicative only to a limited degree, ipilimumab is at present being investigated further in a large, precisely controlled study. My group is taking part and interested patients can obtain information from us and then decide whether to participate."

The latest news is that the team around Prof. Krainer has also started to test a new approach of hormone therapy that is suited as a second-line therapy after initial treatment with docetaxel: MDV3100. MDV3100 is a substance that blocks the androgen receptor and thus offers a new approach to prevent the hormone-dependent growth of the prostate tumour. Explains Prof. Krainer: "Within the framework of a second trial, since December 2009 we have taken part in a phase III trial on the efficacy of MDV3100. It is with good reason that we have been invited, because as early as in 2007 we published a study on the efficacy of docetaxel that has received international attention. This experience is now of course beneficial for us when testing MDV3100."

In that study it was even demonstrated that docetaxel was much more effective than an alternative chemotherapeutic used at the time. This proven efficacy of docetaxel also leads to treatment alternatives in which docetaxel is supplemented with another therapeutic. Precisely such a supplement to standard therapy is being investigated within the framework of a third study at the Department of Medicine I. In this process, docetaxel is tested in combination with sunitinib – a so-called tyrosine kinase inhibitor – and important biomarkers are followed in the patient's blood that provide information about the progress of therapy.

Overall these three trials give Austrian HRPC patients the opportunity of being treated with the currently most modern therapeutics and at the same time make a major contribution to their possible approval.