Why is provenge (immunotherapy) not used in the beginning of treatment

[Jdhanoa]

Hi all,

My father was recently diagnosed with stage 4 prostate metastatic prostate cancer, gleason 4+5. We are all in in state of shock and trying to figure out what the best treatment plan would be for him (he is 65 and was in good health). The research i've done showed provenge (immunotherapy) as an option but it seems like this treatment is not done in the beginning but only when other treatments stop working, I am wondering why that is? Why not start immunotherapy in the beginning of the treatment?

Thank you

[Tall_Allen]

There is a clinical trial with results expected this year for its use in men on active surveillance.

Other trials gave hints that earlier use can be effective:

ascopubs.org/doi/abs/10.120...

goldjournal.net/article/S00...

aacrjournals.org/clincancer...

Unfortunately, Dendreon does not have the resources to pursue trials and new indications.

[Schwah]

I thought the exact same thing. My oncologist did also. As tall Allen says, breakdowns of the study they did on Provenge showed that it worked much better on people with lower PSA counts, implying that it worked better the earlier you used it. So I did something crazy and paid out-of-pocket to do it, while I am still hormone sensitive. it is not for the faint of heart as it is extremely expensive. But my wife and I made the determination that it was worth it. Feel free to private message me if you want more detail.

Schwah

[GAdrummer in reply to Schwah]

My husband started with Casodex and Lupron, then moved on to Ketoconazole and Lupron until he could get on the schedule with Provenge. Once that was completed, he was switched to Xtandi (and Lupron) and got very good results for two+ years. After that failed, nothing else seemed to work very well for any length of time. Finally he got approval for Keytruda and that has him in remission (at great physical cost from side effects).

But the key factoid is: he had nodes only disease. That means he is not the average or usual PC patient. He had leiomyosarcoma [a cancer of smooth muscle usually found in ducts - a hidden killer] in his leg that lead to the discovery of the metastatic prostate cancer.

[Grandpa4 in reply to Schwah]

could you give me ballpark on cost. Closer ton$10,000 or 100,000

[Schwah in reply to Grandpa4]

three sessions cost me $160,000. Not for the faint of heart for sure. Side affects were minimal. Only two flu like days in third infusion.

Schwah

[TJGuy]

At one time not too long ago it was under $100,000. Then overnight the company decided it wanted to charge more for it and it became around $65,000 per session, three sessions constitute a full treatment. So it was close to $200,000. That was like 3 maybe 4 years ago, so let's see what it is today.

[TJGuy in reply to TJGuy]

I believe the company that brought provenge went bankrupt after the drug didn't lower PSA. As such they had no appetite for further clinical trials at different PC disease statues.It is thought to promote additional survival by killing circulating PC tumor cells in your bloodstream. This slows the spread of metastasis. Metastasis are what kill you.