What’s the deal

During the month of November, the world’s eyes lie on men’s health. The public movement movember is aimed at preventing premature death among men; primarily looking at diseases such as prostate- and testicular cancer but also mental health issues. Possibly surprising, prostate cancer is shown to be the second most common type of cancer among men globally. The incidence rate is almost 1.3 million diagnoses per year, and nearly everyone succumbing from prostate cancer gets beyond a point where the disease is no longer responding to standard of care hormone treatment. This late stage, called hormone refractory metastatic prostate cancer (HRPC), is extremely painful and its only available treatment does not substantially add to the patient’s overall survival but rather focus on palliation of the symptoms. This is a loud and clear signal for a high unmet medical need.

Globally, 1.3 million men are estimated to be diagnosed with prostate cancer during 2018, and almost 360 000 men will die from the condition.^1,2 Generally speaking, prostate cancer has three stages. The first include early prostate cancer where it is possible, but not always necessary, to surgically remove the cancer-infected prostate. In the second stage of the disease, patients are treated with hormone treatment, which inhibits the body’s testosterone production limiting cancer cell growth. When the cancer cells have grown resistant to the hormone treatment, the patient enters the third stage which is referred to as hormone refractory metastatic prostate cancer (HRPC) or castrate-resistant prostate cancer (CRPC). At this point, the patients have no chance of getting cured and the remaining treatment options are lacking.

Approximately 90% of the patients with HRPC develop metastases, mainly in the skeleton, and suffer from extreme pain as the growing cancer cells are constantly putting pressure on the inside of the bone. Most commonly, these metastases develop in the skeleton where there is bone marrow, i.e. spine, pelvis, ribs, upper thigh and upper arm, putting a constant pressure from the inside of the bone as the cancer cells grow. This causes an extreme pain and  a treatment used today is where the radioactive substance radium injected into the bone. Currently, the average period of survival for patients affected by HRPC is 9 to 18 months.¹

Currently, the average period of survival for patients affected by HRPC is 9 to 18 months.

During the 21st century, there has been advancements in the field that has shown to extend a patients’ life after diagnosis of HRPC with up to a few months. Yet, most of the treatments under development are aimed at reducing the patient’s suffering rather than prolonging their life, thus only constituting half of the solution for the affected. As a conclusion, there is today a huge unmet clinical need for treatments that can contribute to a patient’s overall survival, i.e. prolong their life, and reduce their pain even more.

References

1. World Cancer Research Fund. Prostate cancer statistics. Available at: https://www.wcrf.org/dietandcancer/cancer-trends/prostate-cancer-statistics Accessed: 30 Nov 2018. 2. World Health Organization/IARC. Cancer Today – GLOBOCAN 2018. Available at: http://gco.iarc.fr/today/online-analysis-multi-bars?v=2018&mode=cancer&mode_population=countries&population=900&populations=900&key=total&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=10&group_cancer=1&include_nmsc=1&include_nmsc_other=1&type_multiple=%257B%2522inc%2522%253Atrue%252C%2522mort%2522%253Atrue%252C%2522prev%2522%253Afalse%257D&orientation=horizontal&type_sort=0&type_nb_items=%257B%2522top%2522%253Atrue%252C%2522bottom%2522%253Afalse%257D&population_group_globocan_id= Accessed: 30 Nov 2018

October 29th is recognized as World Psoriasis Day, which has annually been dedicated to people suffering from psoriasis and psoriatic arthritis. Besides giving the psoriasis community a voice, this day is used to raise awareness, spread accurate information, and improve access to treatment for patients. This year, the International Federation of Psoriasis Association, or IFPA, is dedicated towards the message of “treating psoriasis seriously.”

Psoriasis as such is a chronic inflammatory skin condition. Affecting around 2-4% of the population, it is most often characterized by thick scaling red plaques involving skin and nails. These plaques vary in size, morphology and distribution. These lesions usually cause patients to experience itching, stinging, and pain at different levels of severity.^1,2 After learning about these symptoms, it is not difficult to understand why we need to take these conditions seriously.

One important issue that needs attention is the psychological effect that carrying the disease might have on patients. Psoriasis is a lifelong disease that has a low mortality and high morbidity. Because of this, other issues can arise such as psychosocial disabilities. This can significantly affect a patient’s quality of life.^1,2 In fact, depression and suicidal ideation is prevalent among cosmetically disfiguring dermatological disorders. Additionally, when compared to other dermatology patients, patients with psoriasis and acne have been found to have the highest prevalence of suicidal ideation.^3-5

…compared to other dermatology, patients with psoriasis and acne have been found to have the highest prevalence of suicidal ideation.

There are presently many treatment options available for psoriasis patients. The availability and usage of biologic treatments are increasing, but the main treatment of choice is topical therapies. Although there are a variety of options, dermatologists in key markets such as US, Japan, and the EU5 are highlighting that there needs to be an increase in lower-cost biologics for patients. They also suggest better reimbursement protocols in these same regions. ^6-10

Taking these topics into consideration, we strongly encourage a continuous growth in psoriasis awareness and the other issues that the condition might cause patients, such as psychosocial disabilities. We also hope to see improved patient access to both appropriate and affordable treatment options.

References

1. Armstrong, A.W. et al. 2012. The association between psoriasis and obesity: a systematic review and metaanalysis of observational studies. Nutr Diabetes, Dec 3;2:e54. 2. Parisi, R. et al. 2013. Global Epidemiology of Psoriasis: A Systematic Review of Incidence and Prevalence. J Invest Dermatol, 133(2):377–385. 3. Gupta, M.A. and Gupta, M.K. 1998. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol, Nov;139(5):846-50. 4. Voorhees, A.V. and Fried, R. 2009. Depression and Quality of Life in Psoriasis. Postgraduate Medicine, 121:4, 154-161 5. Chimenti, S. et al. 2006. An Italian Study on Psoriasis and Depression. Clinical and Laboratory Investigations, 212:123-127. 6. Bhutani, T. et al. 2013. Access to health care in patients with psoriasis and psoriatic arthritis: Data from national psoriasis foundation survey panels. JAMA Dermatology, 149:717–21. 7. van Cranenburgh, O.D. et al. 2013 Psoriasis patient’s satisfaction with treatment: a webbased survey study. Br J Dermatol, 169(2):398–405. 8. Cheng, J. and Feldman, S.R. 2014. The cost of biologics for psoriasis is increasing. Drugs Context, Dec 17;3:212266. 9. Takeshita, J. et al. 2015. Psoriasis in the U.S. Medicare population: prevalence, treatment, and factors associated with biologic use. J Invest Dermatol, 135(12):2955–63. 10. Gottlieb, A.B. et al. 2016. Psoriasis trends and practice gaps. Dermatologic Clinics, 34(3), 235–42