I have received lots of email about the recent press releases regarding this drug. To put it into context, I suggest you re-read the post in which I described several of the new drugs that are in the pipeline and work in different ways on prostate cancer cells. I think of MDV as a form of “super casodex”. Not only does it prevent testosterone (and DHT) from binding to the androgen receptor, but it also stops further activation by preventing the AR from translocating to the nucleus. This is important since AR is a protein that binds to DNA and causes genes to be “activated” or transcribed into messenger RNA. The messenger RNA then goes back to the cytoplasm of the cell and is translated into protein. Many of the proteins turn out to be involved with telling cells to divide, survive, and do bad things (if it is a cancer cell), like invade other tissues. MDV 3100 also interrupts the interaction of AR with other proteins known as co-activators and co-repressors. All of these additional actions make it superior to Casodex, which can actually be involved in some cases in stimulating the cancer cell rather than suppressing it. (We almost always do “casodex withdrawal” prior to starting patients on an experimental or toxic therapy to rule this out.)
As usual, the pathway from positive findings announced in the press to being able to get a drug is frustrating to many of my patients. We have one trial running at our center in which patients with rising PSA who have never been treated with ketoconazole, who have minimal pain, and who have castrate levels of testosterone and who have positive scans can receive either MDV 3100 or placebo. However, until the FDA approves MDV 3100, there is really no way to obtain the drug outside of clinical trials. There is a full list of our other prostate clinical trials with the various agents here. We also have a number of novel agents in earlier trials in our developmental therapeutics program.
The good news is that “help is on the way”. The frustrations in the process not being faster are painful, but we are doing all we can!