Immunotherapy in Advanced Prostate Cancer, Part I

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Raoul D. Concepcion, MD, explains that second-line hormonal therapy has not significantly altered the outcome of patients with advanced prostate cancer. He goes on to state, that the institution or withdrawal of bicalutamide does not change the survival of a patient but rather just changes the PSA kinetics. However, sipuleucel-T (Provenge), an FDA-approved therapeutic vaccine for the treatment of asymptomatic or minimally symptomatic patients with castration resistant prostate cancer (CRPC), has demonstrated improvement in survival in clinical trials.

Bryan Mehlhaff, MD, details the process by which sipuleucel-T works. He says that a patient’s white blood cells are filtered from the body, trained to attack prostate cancer cells and put back into the body, via intravenous infusion. Patients often experience flu-like symptoms and are premedicated with Tylenol and Benadryl.

As classically trained surgeons, urologists are often cautious about chemotherapy and the intravenous infusion of sipuleucel-T. In Mehlhaff’s practice, his staff had concerns about the complications sipuleucel-T could cause but have since grown comfortable with the process.

Daniel R. Saltzstein, MD, echoes what Mehlhaff said in that his staff had reservations about the administration of sipuleucel-T at first. Saltzstein also mentions that patients who received sipuleceul-T saw an overall survival advantage of about 4.1 months. The NCCN guidelines state that this is the first-line recommendation to use sipuleucel-T in patients who are asymptomatic or minimally symptomatic with metastatic prostate cancer that are castrate-resistant.

View Part II of the Discussion