New York, N. Y.
• Is one of three NCI-designated
comprehensive cancer centers in
New York state.
• Employed 11,950 people in 2011.
• Admitted 24,486 inpatients and
accommodated 535,900 outpatient
visits in 2011.
Employee and patient data can be found in our
2011 annual report (to be published here in the next
few weeks: http://www.mskcc.org/annual-report).
the fact that in women with early-stage estrogen receptor-positive
breast cancer, tamoxifen treatment reduces the risk of disease
recurrence by almost 50% and the chance of mortality by 30%
The most exciting recent advances in understanding hormone-driven cancers have been made in the area of prostate cancer, the
most commonly diagnosed cancer in the U.S. ( 3). It is estimated
that there will be more than 240,000 new cases of the disease in
2012, and that more than 28,000 American men will succumb to it.
Most prostate cancers, almost two out of every three, are
diagnosed in men aged 65 or older, with African American men
bearing a disproportionate burden of the disease ( 4). The
knowledge that prostate cancer can be powered by hormones
called androgens, like testosterone, provided the rationale for
developing anti-hormone therapies called androgen- deprivation
therapies. These therapies for prostate cancer work in similar ways
to the anti-estrogen therapies used to treat breast cancer: They
lower androgen levels or stop them from attaching to androgen
Androgen-deprivation therapies are most commonly used to treat
advanced prostate cancer. Most individuals with this diagnosis
initially respond very well to these treatments, and their cancers
shrink or grow more slowly. Unfortunately, in most cases, the
prostate cancers eventually stop responding to androgen-deprivation therapies and a more aggressive disease called
castration-resistant prostate cancer arises, which has a very poor
prognosis and urgently requires new treatment options.
While the most frequently used androgen-deprivation therapies
reduce androgen levels, they do not eliminate these hormones
completely. Basic research led to a better understanding of how the
body manufactures and responds to androgens, which revealed a
way to more completely block androgen production. This, in turn,
led to the development of a groundbreaking new anti-androgen
therapy, abiraterone (Zytiga), which the FDA approved in April 2011
for the treatment of metastatic castration-resistant prostate cancer.
In a large-scale clinical trial, abiraterone significantly prolonged
survival ( 91) and provided new hope to patients like Antoni Smith,
p. 55. Ongoing clinical studies are examining whether abiraterone
might provide a more effective treatment than the current standard
of care for prostate cancer patients with less advanced disease.
The results of one of these studies indicate that the presurgical use
of abiraterone in patients with localized high-risk disease shows
promise ( 92).
On August 31, 2012, the FDA approved a new androgen-deprivation
therapy, enzalutamide (Xtandi, formerly called MDV3100).
Enzalutamide attaches to androgen receptors and blocks their
attachment to androgens. It is more effective than current drugs
and has fewer side effects ( 93). The results of a recent large-scale
clinical trial examining enzalutamide as a treatment for metastatic
castration-resistant prostate cancer indicate that it significantly
prolongs survival ( 94). These exciting findings are good news for
patients who desperately need new treatment choices. Continuing
research is assessing the potential of enzalutamide as a treatment
for earlier stage prostate cancer.
Clinical research to further optimize the treatment schedule must
be undertaken soon if patients are to gain the maximum benefit
from recent progress in anti-hormone therapy. For example, the
ideal sequence in which to administer these new drugs, when
during the course of the disease to give them and the best
combination of these and other treatments has yet to be
determined. Moreover, despite the tremendous advances, some
metastatic castration-resistant prostate cancer patients, like S.
Ward “Trip” Casscells, M.D., never respond to either abiraterone
or to enzalutamide, and most individuals who do respond only do
so temporarily. Additional new therapies are required for these
patients, and further research efforts are essential if we are to meet
this medical need.
“I believe it is incumbent upon each of us, especially those of us elected to serve,
to do our part to rid this world of cancer.”
Representative Michael McCaul (R-TX)
Chair, House Childhood Cancer Caucus