San Antonio, Texas USA (UroToday.com) Immunotherapy treatment for prostate cancer has been quite limited given that currently Sipuleucel-T is the only immunotherapy approved for the management of castrate resistant prostate cancer. With the introduction of check-point inhibitors there has been a growing interest in the use of this type of therapies in patients with advanced prostate cancer.
In this session Dr. Yu from the Seattle Cancer Care Alliance presented the current landscape of immunotherapy in the treatment of advanced prostate cancer. The use of immunotherapy for the management of advance prostate cancer has been quite limited due to the limited use of Sipuleucel-T in the clinical setting. Sipuleucel-T is only approved in select cohort of patients with mildly symptomatic castrate resistant prostate cancer, which provides a very short window of opportunity. The effect of the treatment is challenging to follow due to the poor PSA response to therapy, with no response on progression-free survival (PFS) and 4 month improvement on overall survival (OS). In a post-hoc analysis of the Sipuleucel-T trial showed that for the immune system to be able to combat the cancer it requires a small tumor burden, showing the highest survival in patients with PSA levels < 25 pg/mL.
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Given the limited cohort of patients in which immunotherapy appears to be effective there are several ongoing trials looking into immune system priming with the use of chemotherapy and radiation to release neo-antigens for dendritic cell priming. There are also some early work on combination therapy with Pembrolizumab + docetaxel/Enzalutamide which may improve response.
In summary, there is some encouraging early studies that show that immunotherapy have a niche in a select group of patients with advance prostate cancer that could be expanded with immune system priming and combination therapy.
Presented By: Evan Y. Yu, MD, Seattle Cancer Care Alliance
Written By: Andres F. Correa, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center
17th Annual Meeting of the Society of Urologic Oncology - November 30 -December 2, 2016 – San Antonio, Texas USA