Using a blood-based test to personalise treatment for advanced prostate cancer

Professor Attard plans to recruit men with advanced hormone resistant prostate cancer to a clinical trial called PARADIGM. The trial will be national with several centres in the UK recruiting patients. The overall aim of this trial is to determine whether doctors and clinicians can use a simple blood test to determine the treatment that’s most likely to work.

Once they’ve decided to join the trial, men will have a blood test, and Professor Attard and his team will extract the tumour material (DNA) from blood and test it for changes in the gene that instructs the Androgen Receptor, a key driver of prostate cancer growth.

In a previous project funded by Prostate Cancer UK and The Movember Foundation, Professor Attard showed that men whose prostate cancers had specific changes in the Androgen Receptor gene were likely to be resistant to treatments like abiraterone and enzalutamide. This genetic change could be detected in the tumour DNA extracted from blood several months before the man started feeling symptoms of his cancer worsening.

In the PARADIGM trial, Professor Attard will follow up on this work, as well as other data suggesting that although men with these Androgen Receptor gene mutations may be resistant to abiraterone or enzalutamide, they might in fact respond better than expected to docetaxel or cabazitaxel chemotherapy.

Professor Attard and his team will now use his liquid biopsy test for Androgen Receptor changes on men who haven’t already started treatment. They’ll divide men into those with Androgen Receptor changes and those without. Those without the change will continue to be treated as they, and their clinician, think best. Those with the change will be randomly assigned to treatment with either additional hormone therapies like abiraterone / enzalutamide or docetaxel / cabazitaxel chemotherapy.

This trial will first seek to confirm that second-line hormone therapies don’t work well for men with changes to the Androgen Receptor. It will also determine if these same men will actually do much better with chemotherapy instead. Finally, the PARADIGM trial will clearly demonstrate whether testing men for changes to the Androgen Receptor gene as soon as their cancer becomes hormone resistant, then offering them treatment based on the result of that test, would mean that men get access to the medication most likely to work for them the first time round.

If this is successful, Professor Attard hopes that by the end of the trial they will have collected all the scientific data necessary to persuade health regulators to make this test available to all men with hormone resistant prostate cancer, so that doctors can work out which treatment route would be most beneficial for them.

How to get involved with this trial

This trial is still looking for men to take part. You can read the information below to see if you may be suitable to take part in this study, and contact your medical team for full details on whether you can take part.

If you’d like support with deciding whether taking part in a clinical trial is right for you, you can speak to your medical team or contact our Specialist Nurses on 0800 074 8383.

Who can take part

You may be suitable to take part in this study if you have:

  • Advanced prostate cancer and
    • About to start long-term luteinizing hormone releasing hormone (LHRH) suppression, or
    • Started a long-term LHRH antagonist within the last 14 weeks, or
    • Started an LHRH agonist within the last 16 weeks.
  • No other medical conditions likely to reduce life expectancy.

Who can’t take part

You would not be eligible to take part if you::

  • Are also being treated with oestrogen, radiotherapy or surgery, or have any of these treatments planned
  • Have received any other systemic treatments for prostate cancer other than LHRH agonists or anti-androgen treatments
  • Have prostate cancer that has spread to the brain
  • Have been diagnosed with any other cancers or experienced a recurrence within the past 5 years
  • Are unable to have an MRI scan

For full inclusion and exclusion criteria speak to your medical team.

Where the trial is taking place

  • Aberdeen Royal Infirmary
  • St Bartholomew Hospital, London
  • Beatson Cancer Centre, Glasgow
  • Bournemouth Hospital
  • Christie’s Hospital, Manchester
  • Clatterbridge Cancer Centre, Wirral
  • Croydon University Hospital, Surrey
  • Doncaster Hospital
  • Epsom and St Helier University Hospitals
  • Guy’s Hospital, London
  • Kent Oncology Centre, Medway
  • Kingston Hospital, Surrey
  • Royal Marsden Hospital, London
  • Royal Free London, Barnet
  • University Hospital Southampton
  • University College London Hospital
  • Velindre Cancer Centre, Cardiff

Please note, We try to keep this information as up to date as possible, but there may be times when study details have changed and we haven’t updated our web information. Speak to your medical team, or our Specialist Nurses, for the most up to date information on prostate cancer clinical studies.

Grant information

Reference - MA-TR15-007
Researcher - 
Professor Gert Attard
Institution - University College London
Award - £859,367.00