Novel Concepts Include New Agents, Combinations

Anita T. Shaffer @Shaffer1
Published: Tuesday, Jun 19, 2012
Dr. Oliver Sartor

Oliver Sartor, MD

Oncology specialists who treat patients with metastatic castration-resistant prostate cancer (mCRPC) can look forward to choosing from an expanding array of therapeutic tools, including regimens that couple immunotherapy with novel agents and radiation, according to Oliver Sartor, MD.

During his presentation at IPCC, Sartor noted that patients with prostate cancer likely will require multiple drugs to achieve cure rates, just as “it takes four drugs to cure Hodgkin disease, one of our most curable malignancies.”

“I think we’re all looking forward to the day when we can start to combine these agents,” said Sartor, who is medical director and a professor in the Department of Medicine, Section of Hematology & Medical Oncology at the Tulane Cancer Center in New Orleans, Louisiana.

As it stands now, Sartor said there have been six phase III trials either completed in recent years or with interim results in which a survival advantage has been demonstrated in mCRPC (Table).

Novel therapeutics also are in development. Sartor reviewed agents involving these four concepts: immunotherapy, with ipilimumab (Yervoy; Bristol- Myers Squibb) and PROSTVAC-VF-TRICOM (Bavarian Nordic); the targeted alpha-emitter, radium-223 (Alpharadin; Bayer HealthCare); an inhibitor of c-MET and vascular endothelial growth factor receptor 2 (VEGFR-2), cabozantinib (formerly XL184; Exelixis); and the RANK ligand inhibitor and bone-strengthening agent denosumab (Xgeva; Amgen).

Table. Phase III Trials in Metastatic CRPC With a Survival Advantage

Trial Design HR Survivala (months) Differences
TAX 327
N = 1006
Docetaxel/prednisone vs mitoxantrone/prednisone 0.76 18.9 vs 16.5 2.4 months
N = 512
Sipuleucel-T vs control cells 0.78 25.8 vs 21.7 4.1 months
N = 755
Cabazitaxel/prednisone vs mitoxantrone/prednisone 0.70 15.1 vs 12.7 2.4 months
N = 1195
Abiraterone/prednisone vs placebo/prednisone 0.65 14.8 vs 10.9 3.9 months
N = 922
Radium-223 + best standard of care (BSC) vs placebo/BSC 0.70 14.9 vs 11.3b 3.6 months
N = 1199
MDV3100 vs placebo 0.63 18.4 vs 13.6 4.8 months

aSurvival outcomes are not directly comparable because the trials varied on whether docetaxel was administered. Participants in the TAX 327, TROPIC, COU-301, and AFFIRM trials received docetaxel, while most participants in the IMPACT trial did not. Participants in ALSYMPCA either were treated with docetaxel, not a candidate for docetaxel, or received patient's/physician's choice.
b Represents updated data not yet presented.

Sartor O. Immunomodulatory and bone targeted therapeutics in metastatic castrate-resistant prostate cancer. Presented at: 5th Annual Interdisciplinary Prostate Cancer Congress (IPCC); March 31, 2012; New York, NY.


In the area of immunomodulatory therapies in prostate cancer, Sartor said he is “particularly excited” about the prospects for ipilimumab and the PROSTVAC-VF-TRICOM vaccine.

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Online CME Activities
TitleExpiration DateCME Credits
Clinical Interchange™: Translating Research to Inform Changing Paradigms: Assessment of Emerging Immuno-Oncology Strategies and Combinations across Lung, Head and Neck, and Bladder CancersOct 31, 20182.0
35th Annual Chemotherapy Foundation Symposium: Innovative Cancer Therapy for Tomorrow® Clinical Vignette SeriesJan 31, 20192.0
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