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<article id="post-5415" class="post-5415 post type-post status-publish format-standard hentry category-cancer-in-the-news"> <header class="entry-header"> <h2 class="entry-title">Where did abiraterone come from?</h2> <div class="entry-meta"> <span class="sep">Posted on </span><a href="https://web.archive.org/web/20110925093704/http://scienceblog.cancerresearchuk.org/2011/09/21/where-did-abiraterone-come-from/" title="12:01 am" rel="bookmark"><time class="entry-date" datetime="2011-09-21T00:01:33+00:00" pubdate>September 21, 2011</time></a><span class="by-author"> <span class="sep"> by </span> <span class="author vcard"><a class="url fn n" href="https://web.archive.org/web/20110925093704/http://scienceblog.cancerresearchuk.org/author/henrys/" title="View all posts by Henry Scowcroft" rel="author">Henry Scowcroft</a></span></span> </div> </header> <div class="entry-content"> <div id="attachment_5419" class="wp-caption alignright" style="width: 190px"><img class="size-full wp-image-5419" title="Tablets" src="https://web.archive.org/web/20110925093704im_/http://scienceblog.cancerresearchuk.org/wp-content/uploads/2011/09/tamoxifen.jpg" alt="Some tablets next to a bottle" width="180" height="165"/><p class="wp-caption-text">Abiraterone is taken as a daily tablet</p></div> <p>As we’ve reported <a href="https://web.archive.org/web/20110925093704/http://info.cancerresearchuk.org/news/archive/cancernews/2011-09-20-Prostate-cancer-drug-abiraterone-launched-in-UK">on our news feed</a> this morning, abiraterone – a cancer drug that we helped discover and develop – has been launched in the UK following licensing by the European authorities.</p> <p>Men with advanced <a href="https://web.archive.org/web/20110925093704/http://cancerhelp.cancerresearchuk.org/type/prostate-cancer/">prostate cancer</a>, who were treated with abiraterone along with a steroid as part of a <a title="Experimental prostate cancer drug abiraterone clears another hurdle" href="https://web.archive.org/web/20110925093704/http://scienceblog.cancerresearchuk.org/2010/10/11/experimental-prostate-cancer-drug-abiraterone-clears-another-hurdle/">large clinical trial</a>, survived on average for four months longer than men given just the steroid.</p> <p>The drug, developed at the <a href="https://web.archive.org/web/20110925093704/http://www.icr.ac.uk/" target="_blank">Institute of Cancer Research</a> and marketed by <a href="https://web.archive.org/web/20110925093704/http://www.janssen.co.uk/" target="_blank">Janssen-Cilag</a>, is currently only licensed for men whose prostate cancer has become resistant to chemotherapy, and still has yet to be approved by NICE (or its Scottish equivalent, the SMC) for use on the NHS.</p> <p>If suitable, it may be available for men in England through the Cancer Drugs Fund – there’s more about this process <a href="https://web.archive.org/web/20110925093704/http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/cancer-drugs-fund">over on our CancerHelp UK website</a>, where you can also find a detailed <a href="https://web.archive.org/web/20110925093704/http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/abiraterone-for-prostate-cancer">Q&A about abiraterone</a> for patients.</p> <p>We’ve been following abiraterone’s successes on this blog since 2008, when the results of the first major trials <a title="Promising early results for new prostate cancer drug" href="https://web.archive.org/web/20110925093704/http://scienceblog.cancerresearchuk.org/2008/07/22/promising-early-results-for-new-prostate-cancer-drug/">began to emerge</a>. But we thought it would be timely to rewind back to the early 1990s, to the beginning of the story, and look at the invention of the chemical that ultimately became abiraterone.</p> <p><span id="more-5415"></span></p> <h3>The role of hormones</h3> <p>By the 1990s, researchers and doctors had discovered that the key to managing prostate cancer was to shut off its supply of <a href="https://web.archive.org/web/20110925093704/http://en.wikipedia.org/wiki/Testosterone" target="_blank">testosterone</a>, the majority of which is made by a man’s testicles.</p> <p>Over the years, they’d devised <a href="https://web.archive.org/web/20110925093704/http://cancerhelp.cancerresearchuk.org/type/prostate-cancer/treatment/types/treatment-options-for-prostate-cancer">several strategies</a> to do this – initially using castration (orchiectomy, or removal of the testicles), and latterly using hormones like stilboestrol or gonadotrophin-releasing hormone. None of these worked for long; a patient’s <a href="https://web.archive.org/web/20110925093704/http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/psa-for-monitoring-how-well-hormone-therapy-works">PSA levels</a> would gradually start to rise again, and the disease would come back. This became called ‘androgen-independent’ or ‘hormone-refractory’ prostate cancer, and back then there was generally nothing more that could be done.</p> <p>But measuring testosterone levels in these men’s blood during their treatment gave clues as to what was happening. Hormone treatment would cause a large drop in testosterone, but not to zero. Even though testosterone production by the testicles had been ‘turned off’ (so to speak), the small quantities made by other tissues, such as the adrenal glands, were enough to keep the cancer growing.</p> <p>And so the hunt was on for a new drug that could completely shut off the body’s supply of testosterone.</p> <p>Enter a team of chemists led by Professor Mike Jarman, working at what is now the <a href="https://web.archive.org/web/20110925093704/http://www.icr.ac.uk/research/research_divisions/Cancer_Therapeutics/index.shtml" target="_blank">Cancer Research UK Centre for Cancer Therapeutics</a> at the Institute of Cancer Research in Surrey.</p> <h3>Shutting down the testosterone factories</h3> <p>Jarman’s team had read about research from the early 1980s, involving an antifungal agent called <a href="https://web.archive.org/web/20110925093704/http://en.wikipedia.org/wiki/Ketoconazole" target="_blank">ketoconazole</a>, which was known to inhibit a key early step in the body’s testosterone production line – an enzyme called <a href="https://web.archive.org/web/20110925093704/http://en.wikipedia.org/wiki/CYP17A1" target="_blank">cytochrome p450 17A1</a>, or CYP17. Theoretically, targeting this enzyme should shut down testosterone production anywhere in the body.</p> <p>When given to men with advanced prostate cancer, ketoconazole <a href="https://web.archive.org/web/20110925093704/http://www.ncbi.nlm.nih.gov/pubmed/3760119" target="_blank">worked reasonably well</a> at shutting down testosterone production and slowing cancer growth. However, it caused serious side effects, didn’t work reliably and – worst of all – the body broke it down so quickly that men had to be treated three times a day or more.</p> <p>Nevertheless, these small trials showed that targeting CYP17 was a promising idea. So, armed with a detailed understanding of the chemical reactions CYP17 carried out, the team set about trying to make a molecule in the lab that would mimic ketoconazole’s pros, but with none of its associated cons.</p> <h3>“3”</h3> <div class="wp-caption alignright" style="width: 172px"><img title="Abiraterone" src="https://web.archive.org/web/20110925093704im_/http://upload.wikimedia.org/wikipedia/commons/6/69/Abiraterone.svg" alt="Abiraterone" width="162" height="126"/><p class="wp-caption-text">The structure of abiraterone</p></div> <p>In the mid-nineties, the team published the fruits of their labours. In a paper in 1995, <a href="https://web.archive.org/web/20110925093704/http://www.ncbi.nlm.nih.gov/pubmed/7608911" target="_blank">in the Journal of Medicinal Chemistry</a>, they set out details of how they’d made a whole series of compounds, using intricate and carefully controlled reactions.</p> <p>All of these compounds, to some degree, blocked the key reactions carried out by CYP17. In fact, as they wrote in the paper,</p> <blockquote><p>“The most inhibitory compounds in the present study were far more potent than any inhibitor of [CYP17] for which comparable data have previously been described”</p></blockquote> <p>Several of these compounds were extremely promising – they didn’t interfere with other key hormonal processes, and two of them <a href="https://web.archive.org/web/20110925093704/http://www.ncbi.nlm.nih.gov/pubmed/9219927" target="_blank">could completely</a> shut off testosterone production in mice. The most promising of them all was described in the paper simply as “<strong>3</strong>”:</p> <blockquote><p>“The evidence…provided here… makes <strong>3</strong> a strong candidate for further development as a potential candidate for the treatment of prostatic carcinoma in humans”</p></blockquote> <p><strong>3</strong> would eventually be developed into abiraterone acetate, or to give it its brand name, Zytiga.</p> <h3>The rest is history</h3> <p>It took sixteen more years of hard slog, and collaborative scientific and clinical research, to prove that abiraterone could treat prostate cancer.</p> <p>First, the drug had to be ‘formulated’ into a pill that could be taken orally (this was done at our <a href="https://web.archive.org/web/20110925093704/http://spider.science.strath.ac.uk/sipbs/cancer.htm" target="_blank">Strathclyde Formulation Unit</a>). Then, it had to be vigorously tested in clinical trials. We helped support the <a href="https://web.archive.org/web/20110925093704/http://www.ncbi.nlm.nih.gov/pubmed/18645193" target="_blank">initial phase I</a> and <a href="https://web.archive.org/web/20110925093704/http://www.ncbi.nlm.nih.gov/pubmed/19470933" target="_blank">II studies</a>, which took place at the Institute of Cancer Research and the Royal Marsden hospital, before the final, costly phase III trials were carried out with the help of the pharmaceutical industry.</p> <p>Finally it had to go through the various drug-regulatory processes. It has now <a href="https://web.archive.org/web/20110925093704/http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002321/smops/Positive/human_smop_000245.jsp&mid=WC0b01ac058001d127&murl=menus/medicines/medicines.jsp" target="_blank">been licensed</a> to be sold in Europe – and it’s now <a href="https://web.archive.org/web/20110925093704/http://guidance.nice.org.uk/TA/Wave26/4" target="_blank">reached NICE</a>, who are examining whether and how the drug can be made generally available on the NHS.</p> <h3>The future</h3> <p>We’re hoping that NICE makes a speedy appraisal of abiraterone, and that it can be made available to all men who are suitable for treatment. But that’s not the end of the story.</p> <p>Abiraterone has only been proven effective in men with advanced disease that has stopped responding to chemotherapy. We don’t yet know if it will have the same effect when given to men with less advanced disease. This question is being answered in another trial (<a href="https://web.archive.org/web/20110925093704/http://clinicaltrials.gov/ct2/show/NCT00887198?term=abiraterone+302&rank=1" target="_blank">which has now closed</a>) and we’re keenly awaiting the results.</p> <p>And excitingly, abiraterone could be used to treat diseases other than prostate cancer. For example, we’re currently <a href="https://web.archive.org/web/20110925093704/http://cancerhelp.cancerresearchuk.org/trials/a-trial-of-abiraterone-acetate-for-breast-cancer-that-has-spread" target="_blank">helping to support a trial</a> looking at whether it can treat certain forms of breast cancer.</p> <p>The story of abiraterone, from the earliest molecular twinkles in its inventors’ eyes through to a fully licensed pharmaceutical is one that exemplifies all the challenges of discovering new cancer drugs.</p> <p>And even though the story of abiraterone ‘began’ in the 1990s, it wouldn’t have been possible without a prior understanding of prostate cancer’s intimate relationship with testosterone, or of the way the body makes this hormone.</p> <p>That’s why we spend around 40 per cent of our research funding on the <a href="https://web.archive.org/web/20110925093704/http://info.cancerresearchuk.org/cancerandresearch/ourcurrentresearch/topic/cancerbiology/">basic biology of cancer</a> – so we can make more fundamental discoveries like this, and translate them into treatments that will ultimately benefit the people we’re all working for – people with cancer.</p> <p>Henry</p> <ul> <li>If you are affected by prostate cancer, there’s information <a href="https://web.archive.org/web/20110925093704/http://cancerhelp.cancerresearchuk.org/type/prostate-cancer/">on our CancerHelp UK</a> website, including <strong><a href="https://web.archive.org/web/20110925093704/http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/abiraterone-for-prostate-cancer">a detailed Q&A on abiraterone</a></strong></li> <li>If you have a specific question, you can contact our <a href="https://web.archive.org/web/20110925093704/http://cancerhelp.cancerresearchuk.org/utilities/contact-us/">Information Nurses</a> freephone 0808 800 4040, 9am – 5pm Monday to Friday</li> <li>There’s also an <a href="https://web.archive.org/web/20110925093704/http://www.icr.ac.uk/about_us/achievements/Abiraterone/index.shtml" target="_blank">excellent history of abiraterone</a> on the ICR website</li> </ul> <hr/> <p><strong>Reference:</strong></p> <p><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=Journal+of+medicinal+chemistry&rft_id=info%3Apmid%2F7608911&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Novel+steroidal+inhibitors+of+human+cytochrome+P45017+alpha+%2817+alpha-hydroxylase-C17%2C20-lyase%29%3A+potential+agents+for+the+treatment+of+prostatic+cancer.&rft.issn=0022-2623&rft.date=1995&rft.volume=38&rft.issue=13&rft.spage=2463&rft.epage=71&rft.artnum=&rft.au=Potter+GA&rft.au=Barrie+SE&rft.au=Jarman+M&rft.au=Rowlands+MG&rfe_dat=bpr3.included=1;bpr3.tags=Medicine%2CCancer%2C+Hematology">Potter GA, Barrie SE, Jarman M, & Rowlands MG (1995). Novel steroidal inhibitors of human cytochrome P45017 alpha (17 alpha-hydroxylase-C17,20-lyase): potential agents for the treatment of prostatic cancer. <span style="font-style: italic;">Journal of medicinal chemistry, 38</span> (13), 2463-71 PMID: <a href="https://web.archive.org/web/20110925093704/http://www.ncbi.nlm.nih.gov/pubmed/7608911" rev="review">7608911</a></span></p> <div class="pd-rating" id="pd_rating_holder_4922776_post_5415"></div> <p><script type="text/javascript" charset="UTF-8"><![CDATA[//><!]]></script></p> <div class="snap_nopreview sharing robots-nocontent"><ul><li class="sharing_label">Share this:</li><li class="share-twitter share-regular"><div class="twitter_button"><iframe allowtransparency="true" frameborder="0" scrolling="no" src="https://web.archive.org/web/20110925093704if_/http://platform.twitter.com/widgets/tweet_button.html?url=http%3A%2F%2Fscienceblog.cancerresearchuk.org%2F2011%2F09%2F21%2Fwhere-did-abiraterone-come-from%2F&counturl=http%3A%2F%2Fscienceblog.cancerresearchuk.org%2F2011%2F09%2F21%2Fwhere-did-abiraterone-come-from%2F&count=horizontal&text=Where%20did%20abiraterone%20come%20from%3F: " style="width:97px; 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class="widget-title"><a class="rsswidget" href="https://web.archive.org/web/20110925093704/http://info.cancerresearchuk.org/rss/?rsstype=news" title="Syndicate this content"><img style="border:0" width="14" height="14" src="https://web.archive.org/web/20110925093704im_/http://scienceblog.cancerresearchuk.org/wp-includes/images/rss.png" alt="RSS"/></a> <a class="rsswidget" href="https://web.archive.org/web/20110925093704/http://info.cancerresearchuk.org/index.htm" title="Latest updates from Cancer Research UK">On our news feed</a></h3><ul><li><a class="rsswidget" href="https://web.archive.org/web/20110925093704/http://info.cancerresearchuk.org/news/archive/pressrelease/2011-09-22-Professor-Marais-to-lead-Paterson?rss=true" title="CANCER RESEARCH UK and The University of Manchester have appointed Professor Richard Marais to be the next director of the Paterson Institute for Cancer Research in Manchester. […]">Skin cancer expert to lead Manchester's Paterson Institute</a> <span class="rss-date">September 22, 2011</span></li><li><a class="rsswidget" href="https://web.archive.org/web/20110925093704/http://info.cancerresearchuk.org/news/archive/cancernews/2011-09-21-Scientists-find-first-ever-gene-fusion-in-ovarian-cancer?rss=true" title="In a world's first, US researchers have found a particular gene fault - called a gene fusion - is present in a significant proportion of difficult-to-treat ovarian cancers. […]">Scientists find first ever 'gene fusion' in ovarian cancer</a> <span class="rss-date">September 21, 2011</span></li><li><a class="rsswidget" href="https://web.archive.org/web/20110925093704/http://info.cancerresearchuk.org/news/archive/cancernews/2011-09-20-Prostate-cancer-drug-abiraterone-launched-in-UK?rss=true" title="A new prostate cancer drug, developed with support from Cancer Research UK, has been launched in the UK following its licensing by the European Medicines Authority. […]">Prostate cancer drug abiraterone launched in UK</a> <span class="rss-date">September 20, 2011</span></li><li><a class="rsswidget" href="https://web.archive.org/web/20110925093704/http://info.cancerresearchuk.org/news/archive/cancernews/2011-09-19-Glowing-cells-guide-ovarian-cancer-surgery?rss=true" title="Dutch surgeons have performed the first ever surgical procedures on ovarian cancer patients using new technology that illuminates ovarian cancer cells, making it easier to detect and remove tumours. […]">Glowing cells guide ovarian cancer surgery</a> <span class="rss-date">September 19, 2011</span></li><li><a class="rsswidget" href="https://web.archive.org/web/20110925093704/http://info.cancerresearchuk.org/news/archive/cancernews/2011-09-16-New-insight-into-how-alcohol-is-linked-to-breast-and-liver-cancers?rss=true" title="A US laboratory study has revealed how the breakdown of alcohol in human cells results in DNA damage that causes cell changes linked to cancer. […]">New insight into how alcohol is linked to breast and liver cancers</a> <span class="rss-date">September 16, 2011</span></li></ul></aside><aside id="facebooklikebox-3" class="widget widget_FacebookLikeBox"><h3 class="widget-title">On Facebook</h3><iframe src="https://web.archive.org/web/20110925093704if_/http://www.facebook.com/plugins/likebox.php?href=https://www.facebook.com/cancerresearchuk&width=200&colorscheme=light&show_faces=true&connections=6&stream=false&header=false&height=435" scrolling="no" frameborder="0" style="border:none; overflow:hidden; width:200px; height:435px;" allowtransparency="true"></iframe><a href="https://web.archive.org/web/20110925093704/http://cmsvoteup.com/joomla-extensions/facebook-like-box-like-recommendation-for-joomla-wordpress/" title="Free Facebook Like Box for Wordpress" target="_blank"><img src="https://web.archive.org/web/20110925093704im_/http://www.cmsvoteup.com/images/power_by_2x2.gif" border="0"/></a></aside><aside id="linkcat-109" class="widget widget_links"><h3 class="widget-title">Other sites we like</h3> <ul class="xoxo blogroll"> <li><a href="https://web.archive.org/web/20110925093704/http://acspressroom.wordpress.com/" title="The American Cancer Society’s press team" target="_blank">ACS Pressroom blog (US)</a> The American Cancer Society’s press team</li> <li><a href="https://web.archive.org/web/20110925093704/http://policyblog.amrc.org.uk/" title="Becky Purvis, from the Association of Medical Research Charities, blogs about research policy" target="_blank">AMRC policy blog</a> Becky Purvis, from the Association of Medical Research Charities, blogs about research policy</li> <li><a href="https://web.archive.org/web/20110925093704/http://www.cancer.org/AboutUs/DrLensBlog/default" title="A blog from the American Cancer Society’s Deputy Chief Medical Officer" target="_blank">Dr Len's cancer blog (US)</a> A blog from the American Cancer Society’s Deputy Chief Medical Officer</li> <li><a href="https://web.archive.org/web/20110925093704/http://www.nhs.uk/News/Pages/NewsIndex.aspx" title="Health news, explained by the NHS" target="_blank">NHS Choices – Behind the Headlines</a> Health news, explained by the NHS</li> <li><a href="https://web.archive.org/web/20110925093704/http://wellcometrust.wordpress.com/" title="The Wellcome Trust’s blog" target="_blank">Wellcome Trust blog</a> The Wellcome Trust’s blog</li> </ul> </aside> <aside id="archives-2" class="widget widget_archive"><h3 class="widget-title">Monthly archives</h3> <select name="archive-dropdown" onchange="document.location.href=this.options[this.selectedIndex].value;"> <option value="">Select Month</option> <option value="http://scienceblog.cancerresearchuk.org/2011/09/"> September 2011  (7)</option> <option value="http://scienceblog.cancerresearchuk.org/2011/08/"> August 2011  (17)</option> <option value="http://scienceblog.cancerresearchuk.org/2011/07/"> July 2011  (20)</option> <option 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