Immunotherapy for prostate cancer con... - Advanced Prostate...

Advanced Prostate Cancer

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Immunotherapy for prostate cancer continues to disappoint, but at least we are learning why

Tall_Allen profile image
13 Replies

I've updated this article about the importance of timing in prostate cancer therapies with the early results of the "CHECKMATE 650" clinical trial that combined nivolumab (Opdivo) and ipilimumab (Yervoy). Only 25% of men with mCRPC who hadn't yet had chemo had any early response (and only 10% of men who had had chemo). This is better than the "no response" when used alone, but worse than the response seen by either when used separately for melanoma (the recurrence-free survival (RFS) rate at 18 months with Opdivo was 66.4% and 52.7% for Yervoy (ipilimumab)). It is too early to say whether there will be any change at all in recurrence-free survival or overall survival in prostate cancer patients. The toxicity of the tested combination was unacceptably high, and several deaths due to treatment occurred.

Comparing the men who had some early response to those who didn't, it appears that the cancer had to advance to a point where there was a high mutational burden and the PD-L1 protein appeared on more than 1% of cancer cells. So it seems that for a combination of these checkpoint inhibitor-type immunotherapies, later use may be preferable to early use.

Here's the article:

pcnrv.blogspot.com/2019/02/...

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Tall_Allen profile image
Tall_Allen
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13 Replies
tallguy2 profile image
tallguy2

Thanks for posting this, Allen. I've seen little to suggest that the time and expense of Provenge are worth it. I know that much, much research is underway to develop precision medicines to tackle MPCa. Let's hope this work bears fruit in the years to come.

Tall_Allen profile image
Tall_Allen in reply to tallguy2

I think Provenge can help, particularly in conjunction with radiotherapy (SBRT particularly) or with chemotherapy. Those therapies make available a lot of cancer antigens that the amped up immune cells can be activated with, increasing the abscopal effect.

But I also acknowledge Provenge's shortcomings - it doesn't reduce PSA or slow progression measurably, but it does increase survival. Naysayers point out that the apparent increase in survival was caused by the depleted dendritic cells in the control group because their dendritic cells weren't incubated in the same way. They have a point, but the body does naturally replace the depleted dendritic cells pretty quickly.

tallguy2 profile image
tallguy2 in reply to Tall_Allen

Understood. I add that some medical insurance will not cover Provenge prior to other therapies, even though, according to the Prostate Cancer Foundation, "Sipuleucel-T (Provenge®) is a cell-based prostate cancer vaccine that has been approved by the FDA for men with metastatic hormone therapy resistant prostate cancer. This treatment is meant for men with minimal or no pain, and is most commonly given before chemotherapy, although it appears to be effective in some men even after chemotherapy."

Tall_Allen profile image
Tall_Allen in reply to tallguy2

I don't know if the best timing with SBRT is before, during or after. Since there are 3 infusions, i figure - why not do one of each? In conjunction with chemo, there is more time, and the immune boost (with GM-CFS) is similar to what is often given to turn-around neutropenia from chemo anyway. I haven't seen any pushback from insurance as long as the man is metastatic and castration-resistant.

j-o-h-n profile image
j-o-h-n in reply to Tall_Allen

Oh BTW I like you too.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/28/2019 7:48 PM EST

TWTJr profile image
TWTJr in reply to Tall_Allen

TA, thanks so much for your erudite posts and insight. I hope all members appreciate the work you do and your generosity in sharing it.

Flydoggy profile image
Flydoggy in reply to TWTJr

I second that...big thanks to Tall_Allen

KSK54 profile image
KSK54

Thanks TA for the efforts you take and give the latest to all.

monte1111 profile image
monte1111

Thank you for all you do Tall_Allen. When I graduate to Provenge I will ask for Xofigo at the same time. Xtandi has worked well for 18 months.

Crabcrushe profile image
Crabcrushe

You are an invaluable Godsend.

shueswim profile image
shueswim

I'll add my voice to the chorus of appreciation. I've learned much from this forum, and TA in particular. Knowledge is essential as we navigate our way through this journey and interact with our medical teams.

Kudos from me as well. I would be remiss not to complement you on all the information you provide for us. Thank you!

This post is relevant for me as Provenge or Xtandi are the two treatments my MO mentioned as my next options to consider on March 6th.

j-o-h-n profile image
j-o-h-n

Remember, Me---->lung melanoma----->MSKcc-------->keytruda---->working.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/28/2019 7:46 PM EST

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