Dr. Ryan Discusses Sequencing Prostate Cancer Therapies

Charles J. Ryan, MD, medical oncologist, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, discusses sequencing therapies for chemotherapy-naive men with metastatic castration-resistant prostate cancer (CRPC).

The two currently approved treatments for patients with CRPC who have not received chemotherapy include the immunotherapy sipuleucel-T (Provenge) and chemotherapy. Ryan notes that abiraterone acetate may also soon be available in this setting, if the COU-AA-302 trial results in FDA approval (Find out more: Dr. Ryan on the COU-AA-302 Interim Analysis Results).

Ryan views three distinct patient populations for each of the available treatments. He recommends that patients who are asymptomatic or indolent, who aren't sick enough to receive chemotherapy, should be treated with sipuleucel-T. Additionally, he notes patients should receive chemotherapy if they demonstrate symptoms and don't meet the criteria for sipuleucel-T or abiraterone acetate.

A large group of patients who have asymptomatic, progressive, CRPC will find themselves in the space between chemotherapy and sipuleucel-T. Ryan believes these patients are the ideal candidates to receive abiraterone acetate.

Many of the therapies used to treat CRPC are relatively new and have not been tested together for adverse interactions. With this in mind, Ryan cautions that the prednisone used along side abiraterone acetate may have an adverse effect on the efficacy of sipuleucel-T. He advises that the two therapies should not be given consecutively without an ample washout period.