Car T vs Provenge treatment

[joeguy]

Do any of the wise sages on here know if Car T and provenge are basically the same thing? I have heard great things about Car T treatment with blood cancers, but didnt know if it had any potential for PC. From what I can tell about Provenge, it may or may not do anything.

[Tall_Allen]

They are very different, although they both activate an immune response. The biggest difference to the patient is that Provenge is approved for all men with mCRPC, while CAR-T is only available in clinical trials for heavily treated men.

Provenge extends life, but it does not affect PSA. That's why some people don't believe it does anything. How does one know if it is extending one's life? I think it is best combined with a therapy that increases antigen presentation, like radiotherapy, chemotherapy or Xofigo.

[joeguy in reply to Tall_Allen]

Thanks TA, my Urologist wanted me to do Provenge a couple years ago when I went castrate resistant, but i declined it at the time due to high cost, questionable results, and heart related issues I was having at the time. Not sure if its something I will consider in the future of not.

[Tall_Allen in reply to joeguy]

I don't think the results of Provenge are questionable - men live longer.

nejm.org/doi/full/10.1056/n...

To qualify for CAR-T (or BiTE) trials, you would have had to have failed at least one second-line hormonal agent and chemo.

[AllenMarco in reply to Tall_Allen]

Will the benefit of Provenge be apparent on a follow up PSMA scan? I have multiple abdominal lymph nodes that lit up pre treatment. PSA 4. I’m in the midst of Provenge treatment.

[Tall_Allen in reply to AllenMarco]

I haven't seen anything about it. Let us know.

[Javelin18]

Both use the immune system, but in different ways. Provenge draws dendritic cells from the patient. Dendritic cells are the body's natural agent for training T cells. Once removed, the dendritic cells are primed with a cancer antigen, then reinjected. Once inside, they train the existing T cells.

With CAR-T, T cells are removed and genetically modified to recognize cancer antigens. They are reinjected to kill the cancer.

Both use T cells to do the killing, but different paths to train T cells. Once a T cell has attacked a cancer cell it is used up,

CAR-T therapy often leads to Cytokine Release Syndrome ( CRS ), a less acute form of the cytokine storm that was seen in the early days of Covid. In anticipation of this, CAR-T trial patients are kept in the hospital for monitoring following the first few treatments.

[joeguy in reply to Javelin18]

interesting.......... I had heard of the trained cells sometimes attacking things other than cancer. I was told they are pretty good at turning the cells on, but not very good at switching them off when they go wrong.

[Javelin18 in reply to joeguy]

Immune system is incredibly complex.

I think when the immune system attacks an invader, it releases cytokines to signal other leukocytes to join in the fight. That can lead to a cascade of more leukocytes attacking the the invaders, then releasing more cytokines . The cascade can be so strong that normal cells get attacked.

They use organ donor rejection drugs to stop the cascade. From my discussion with doctors this is manageable in the hospital setting. I came away with the impression that it is just part of the plan.

[Javelin18]

Nal, It's been a while since your post, but I'm still left wondering what you mean about new CAR-T trial treatments being light years ahead of prior CAR-T treatments for other cancers. Can you explain this?

[SuppWife]

Hi, Nal, any update on this? If you posted it elsewhere forgive (and direct me).

[SuppWife]

Great! I look forward to it! 🙏🏻