Understanding the current medical landscape of prostate cancer

Thought LeadersDr. Simon Chowdhury & Laetitia GuillouxConsultant Medical Oncologist & VP of Janssen OncologyJanssen Oncology

In this interview, News-Medical talks to Dr. Simon Chowdhury, Consultant Medical Oncologist, and Laetitia Decroix Guilloux, Vice President, EMEA Commercial Strategy Lead at Janssen Oncology, to discuss the unmet needs in prostate cancer, scientific advancements, and Janssen’s heritage in the disease area.

Dr. Simon Chowdhury, Consultant Medical Oncologist, London, UK

What is the current prostate cancer disease landscape in Europe?

Prostate cancer is the most common cancer in European men with approximately 473,000 men diagnosed in 2020.^1,2 Within that population, around 50,000 are estimated to be living with a form of the disease called metastatic hormone-sensitive prostate cancer (mHSPC), which is when advanced prostate cancer still responds to treatments that lower testosterone.^3,4 Sadly, deaths from prostate cancer in Europe are at 75,000 every year.⁵

No two prostate cancers are the same. The disease may be localized, low-volume, low-grade, that would never cause any problems. However, it can also present with locally advanced and metastatic disease. A timely diagnosis is critical to delaying this progression.^6,7 There's an ongoing narrative that prostate cancer is a disease of old men who die of other causes.⁸ That isn't wholly true, and it's a dangerous narrative that we need to change. Prostate cancer causes a large amount of suffering, and advanced disease is lethal in almost all cases.^8,9 It's heterogeneous, but that doesn't mean we should underestimate it.

Not only is the narrative wrong but we’re not including everyone in our efforts to improve prostate cancer care. Black men are disproportionately affected by prostate cancer,¹⁰ and we need to make sure that we are reaching all communities in the right way, considering cultural, language, and health literacy barriers.

Image credit: Janssen Oncology

Efficacious treatments are available, including surgery, radiotherapy, hormonal therapy, chemotherapy, and novel drug therapies coming through.¹¹ We must do our best to make sure that all patients access these swiftly. Often it is at the earliest point that treatment shows benefit.

From your experience, how has the landscape and awareness of prostate cancer changed over the past 10 years?

With the growth of large-scale awareness campaigns, such as Movember, highlighting the symptoms and risk factors,¹² more people may feel empowered with the information they need to seek out a diagnosis and receive treatment earlier. In the UK alone, we have seen a 16% rise in prostate cancer diagnosis in the last 10 years.¹³

There have been some gains in treatment also. As we make scientific advancements, we have seen the overall cancer death rate decline over the past 10 years.¹⁴ Precision medicine is evolving. We now have some precision medicines which are based on genomic information, driving progress in the advanced prostate cancer space – helping those most in need.

However, a lot of work still needs to be done. The risk of developing prostate cancer increases with age,¹⁵ and with an aging population across Europe, the prevalence of prostate cancer, which has doubled since 1995, is rising.^5,16 Sadly, it is estimated that there will be over one million new cases up to 2040 (+79.7% overall change).¹⁷

Image credit: Janssen Oncology

What are the key challenges we must overcome in prostate cancer to improve long-term outcomes and maximize the quality of life for patients?

One of the biggest challenges will be increasing demand from the rising number of prostate cancer patients. But it’s not only about the number of patients, it’s also about their complexity and striving to maximize benefits for all. That means selecting the right treatment for the right patient to ensure that they have the most benefit and better efficacy, while also making sure that we stop treatments when they don't work.

We cannot overcome these challenges separately. Collaboration with both pharma and government is key. Our relationship with these two stakeholders must be much closer. It is a true cross-sector collaboration that's going to help to drive progress here, with pharma, regulatory bodies, and patients all working together.

Fundamentally, we don't have great screening tools to identify the highest risk patients. On top of that, better education and awareness is needed around risk factors and common symptoms – particularly for those over 50 years old, of black ethnicity, and with a family history of prostate cancer. This gives more opportunities to diagnose and treat quickly. That’s the key – if we can prevent progression to advanced-stage disease, we can double five-year survival rates.^8,18,19

What are the current treatment approaches?

There are several new treatments coming through for metastatic prostate cancer. It's a hugely innovative time, and the pharmaceutical industry is to be thanked for driving that process. For me, Janssen is at the forefront of that.

Janssen is also looking at learning from the other aspects of the oncology pipeline, specifically the wonderful work that has been done in myeloma and looking at targets such as prostate-specific membrane antigen (PSMA). I believe this innovation will make a real difference going forward.²⁰

What are the key challenges we must overcome in order to maximize the effectiveness of these treatment approaches for patients?

We don't focus enough on the wider impact of a diagnosis; on the mental illness aspect or how a diagnosis affects the patient's family and friends. In short, we don't look at the holistic impact that prostate cancer has.

Image credit: Janssen Oncology

Many people are unaware how a man being ill can impact his partner, his children, his friends. We focus too much on the drug cost, but there are big societal costs that we should appreciate more.

What does the future look like for prostate cancer?

The future is exciting but also incredibly challenging. We need to work closely with companies, such as Janssen, who have a fantastic heritage in prostate cancer and oncology in general.

The difficulties will come from finite healthcare resources and the increasing complexity of diseases, but we mustn't underestimate patient issues such as the side effects of treatments. Those side effects are both physical and psychological and affect sexual function, which is something we shy away from, and many men are unaware of.

COVID has changed the way we all think, work and interact with each other in a positive way. We should imbed these changes into how we continue to work together in the future. We need to constantly challenge ourselves to collect the data, to feed that back, to challenge the government, and to get a healthcare system that is fit for our patients. So, when I say, "Why don't you ask patients what they want?" People look at me and think, that’s not a bad idea at all.

Laetitia Decroix Guilloux, Vice President, EMEA Commercial Strategy Lead, Janssen Oncology

What is Janssen’s heritage in prostate cancer?

The heritage of Janssen in prostate cancer is quite extensive. In recent decades, we have been actively engaged in transforming the future of prostate cancer care. Thus, from our first approval in 2011, we have continued to build on the insight of our clinical research, leading us to now having five approved indications in that area.^21,22,23

How is Janssen supporting patients diagnosed with prostate cancer?

One of our main goals and targets in this area is to prevent progression to advanced disease. We want to give back time and quality of life to the patient living with prostate cancer. I would like to highlight three areas of how we do that, that are of particular importance to me.

Firstly, we want to push the boundaries of our understanding of prostate cancer and look at new ways of tackling it before it takes hold in the body. This new strategy is called cancer interception, and it aims to determine why some healthy cells become cancerous. We hope this strategy will result in treatments that interrupt the process and potentially block disease growth.²⁴

Our second approach is to move away from a one-size-fits-all diagnosis of prostate cancer. Instead, we are considering every patient as unique based on their disease and their life. The way that we have translated this personalised approach into our development comes from championing the patient voice in our research and clinical development programs. With that, we hope that we will be able to support every patient as best as we possibly can throughout their journey.²⁴

Image credit: Janssen Oncology

The final element involves combining big data with artificial intelligence to analyze electronic patient health records. There are two reasons for this, the first being to gain a better understanding of the disease in terms of epidemiology, diagnosis and treatments, and the second being to help inform our future approaches. We hope that in doing so, we'll be able to continue to advance our understanding of prostate cancer and improve the lives of patients.²⁴

About the interviewees

Laetitia Decroix Guilloux, Vice President, EMEA Commercial Strategy Lead, Janssen Oncology:

Laetitia Decroix Guilloux, PharmD, e-MBA, is the Vice President, EMEA Commercial Strategy Lead at Janssen Oncology.

She is an established executive with a demonstrated history of working in the pharmaceuticals industry and extensive experience in oncology.

Dr. Simon Chowdhury, Consultant Medical Oncologist, London, UK

Simon Chowdhury received his first degree from the University of Cambridge and qualified as a doctor at Guy's and St Thomas' Medical School.

He completed his PhD in tumour targeting at University College London and also trained at St George's and The Royal Marsden Hospitals. He is actively involved in clinical trial research into urological cancer and especially prostate cancer.

He is on the steering committee for several studies that have shown potentially practise changing results for men with prostate cancer.

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