An Interview With Professor Nicholas James: Part 1

Professor Nicholas James is Chief Investigator on the groundbreaking STAMPEDE trial. The multi-arm, multi-stage trial focuses on people with locally advanced or metastatic prostate cancer starting first-line hormone therapy. It seeks to improve outcomes and reduce side effects by adding new treatments to the standard approach or modifying the type of hormone therapy. The trial involves at least 10,000 patients and compares new treatment approaches to a "control arm," or the current standard treatments.1,2

The findings thus far

The trial finding's so far suggest that Docetaxel chemotherapy, if given at the time of long-term hormone therapy initiation, can improve survival.2 The trial's findings have also suggested that androgen deprivation therapy (ADT), plus abiraterone and prednisolone, can improve survival, compared to just ADT alone.3

I’m pleased to say that Prof. James agreed to do an interview with me, and this is Part 1 of that interview. You can also read Part 2.

The interview

Biggest breakthroughs

Tony: Professor, you are the Chief Investigator on the STAMPEDE trial that started in 2005 and has had over 10,000 patients involved in the trial. It would be fair to say that the trial has been groundbreaking in terms of treatment regimens for advanced stage prostate cancer. Could you please tell me what you consider to have been the biggest breakthrough to date, and how it has impacted prostate cancer care and overall survival rates?

Prof. James: I think all three of the positive arms have had big global impact. Radiotherapy, docetaxel, and abiraterone. I would not wish to pick one over the others. The trial design itself was also very important and has been used as the basis for many other studies such as the COVID RECOVERY trial.

Better alternatives

Tony: When I was diagnosed stage 4 in May 2017, I was training to run one of the world’s toughest ultra-marathons and literally went from training for an ultra to an incurable cancer diagnosis in a matter of days. It turned out to be a pretty serious groin strain! The standard of care for advanced stage prostate cancer has for many, many years been ADT, but I’ve found the impact of ADT devastating both as a man and as an athlete. Do you think there will ever be a day where ADT isn’t standard of care, and what do you think could replace it? Are there any better alternatives that might lessen the impact of current ADT treatments like Prostap and Zoladex?

Prof. James: In the short term, these may get partly replaced by oral therapies such as enzalutamide or apalutamide. Given as monoRx (single drug therapy) these are less impactful. Other ways of sparing ADT such as SABR (stereotactic ablative radiotherapy) and treatment breaks are likely to become more prominent as well.

Looking at outcomes

Tony: It is suggested that combining Abiraterone with ADT is more effective than combining Docetaxal with ADT for men with advanced disease. However, it’s frustrating that we still don’t seem to know how much better and also how much better in terms of overall survival. Do you have any thoughts on what the likely position will be and when we’ll be able to statistically prove better outcomes using Abiraterone instead of Docetaxel?

Prof. James: Not every trial can be done, so we will probably never know for sure.

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