When to Use Provenge?

Has anyone been told that Provenge should be used when the cancer burden is low? We know it is not quick acting and it is hard to measure progress --maybe that has something to do with it.

[Neal-Snyder]

After the research on late-stage men showed a 4 1/2 month survival benefit, there was research on earlier stage men. My understanding is that they didn't find a benefit with them, & that Provenge, an expensive treatment, lost some of its luster. I hope people with more info will also reply.

[PaulTaylor]

I've had several opportunities to speak with Dr. Jim Gulley, from NCI, who is one of the best out there with immunotherapies and prostate cancer (he is one of the leading developers of ProstVac, a nextgen immune therapy for PCa).  All of his research points to the use of Provenge when tumor burden is low, with a patient who has time to allow the treatment to work over time.  Furthermore, he advocates for combination therapies - I'm a good example of that.  After being diagnosed at age 41 with a PSA of 80, and lymph node metastasis in the pelvis, abdominal, and retroperitoneal areas, I embarked on an aggressive treatment plan to debulk my tumor load and reduce PSA, in order to do Provenge. My treatment included Lupron, Avodart and Casodex, followed by Zytiga, early course chemo with taxotere, and surgery.  All of this resolved my lymph node activity, and took my PSA to 1.0.  After I started to fail Zytiga (based on rising PSA and lymph node activity in a single node), I switched to Xtandi.  After a month, Xtandi had resolved the lymph node activity, and my PSA was decreasing.  At his point, my team and I thought Provenge was a good option, given reducing PSA and no evident tumor burden.  While remaining on Xtandi, and following Provenge, I have had an undetectable PSA and no evidence of disease for just over two years.  I expect that the future addition of checkpoint inhibitors to advanced hormone therapies and immune therapies, in combination, will increase the ability to maintain long periods of stability in PCa.

[Hidden in reply to PaulTaylor]

Paul,

I was watching a video of Dr. Szmulewitz (University of Chicago).  There was talk of combining Provenge with Radium 223.  In general, there seems to be a movement away of mono treatments at the research centers.  The approach was to  hit the cancer "in the jaw, stomach and the knees."  At the same time there still needs to be a lot of research around combinations and the sequences.

[David20451 in reply to PaulTaylor]

My story is very similar. Lymph node mets. Rising PSA on Zytiga. Debulked with SBRT. Provenge and Xtandi. Undetectable PSA for 2 years.

[andrew61 in reply to PaulTaylor]

Hi Paul

I have a similar PCa to you and have so far followed your path since diagnosis last October. I'm on Lupron + Zytiga, just finished 6 x Chemo. About to have radiation on prostate & local nodes.

What physician agreed to early Provenge and Metformin + Statin?

My physician isn't interested in Metformin.

Thanks Andrew

[PaulTaylor in reply to andrew61]

I did not go on everything at once - it took a while to convince various care teams. My doctors at Walter Reed and NCI approved the Provenge - I started treatment at MD Anderson (I was in the Army and moved around a bunch early on) and I had always discussed with my onc there about Provenge if I was able to control PSA well and reduce tumor volume). I later convinced my Walter Reed oncologist to add Metformin as a maintenance drug - there are good arguments for use of Metformin - at the end of the day, she wasn't that convinced, but I also asserted that Metformin was safe and cheap, so why not try it? I wasn't able to get my care team to add a statin until I moved to Kansas City, and was referred to a cardiologist - he had no issues adding it, as long as my liver tests continue to come back good.

[mshariff]

In my case, it was a total waste of money and made matters worse by not controlling PSA through some other means. There is no tangible indication as how effective this drug has worked.

[Magnus1964]

Last March spots showed on my lungs. The assumption was PC spread to lungs. I went on Provenge and the spots disappeared. I am still fighting a high PSA but the spots are gone and so far after one year they have not returned.

[JoelT]

There is no question that the earlier Provenge is used after you become castrate restistant the better the chance you have in obtaining a positive result.  Provenge is different than the other treatments we have for advanced prostate cancer.  It does not directly kill cancer cells like chemotherapy does, it sensitized your own, natural immune system to see the cancer as an invader in your body. Then, your own natural defenses kill the cancer cells.  

When your white blood cells (T) are removed from you and shipped to Dendreon the cells go through a process where they are sensitized to see the cancer not as your own cells, but as invading cells. This is done by attaching a protein to the T cells surface.   

Your own treated cells ar then re-infused back into you where they recruit the other untreated  T cells and "train" them to also see the prostate cancer as invading the body.  

Even though the three infusions take only one month the "training" process can take six or more additional months before the treatment starts to have an effect.  The positive effect continues on for a yet undetermined time period. 

 There is also some evidence that the lower the aggressiveness of the cancer the more effective the treatment. Generally, men with Gleason scores of 7 or less will do better than men with Gleason scores of 8 or more.  

In summary, the lower your tumor burden (the earlier in time after you become castrate resistant) and the lower the Gleason score the more benefit you will receive from Provenge.

Joel