New Therapies for Prostate Cancer: The Practicalities

Jeannette Y. Wick, RPh, MBA
Published: Tuesday, May 15, 2012
Color-enhanced image depicts prostate cancer cells

Scanning electron color-enhanced image depicts prostate cancer cells.
Photo courtesy Annie Cavanagh/Cell Image Library

Unlike other cancers, the treatment options for prostate cancer have remained fairly consistent over the last decade. Research has been stymied by the bland molecular sub-characterization of prostate cancer in contrast to other cancers. For example, breast cancers may or may not express hormone receptors, and various expressions are strongly linked to response. Prostate tumors—all of them—have androgen receptors. All first-line treatments have been androgen-directed, especially initially.

Urologists and oncologists have had several treatment protocols to choose from, all approximately the same in terms of overall efficacy, although patient response has been variable. The general treatment steps have been androgen deprivation, second-line hormonal manipulations, and chemotherapy. Throughout, bone health has been a concern.

Now, with four new agents approved in the last two years (Table) and two promising agents in the pipeline, therapy selection and potential outcomes are changing.

Dr. Oliver Sartor

Oliver Sartor, MD

Each of the four newest therapies has been proven to improve overall survival or to delay skeletal-related events better than the standard therapies available prior to their approval. According to Oliver Sartor, MD, Laborde Professor for Cancer Research and medical director at the Tulane Cancer Center, New Orleans, Louisiana, “Urologists make strong bonds with their patients, and often follow them for years. All of these agents will be useful to urologists, although they may prefer to have patients with advanced disease treated in the medical oncology setting.”

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Sipuleucel-T

This autologous cellular immunotherapy induces an immune response targeted against an antigen expressed in 95% of prostate cancers, prostatic acid phosphatase (PAP). The FDA approved its use for asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer (CRPC).1,2

Sipuleucel-T offers a new option—immunotherapy— between initial androgen deprivation and second-line hormone manipulation. Using multiple agents to attack different parts of the neoplasm’s growth cycle is a general approach in most cancers. The sipuleucel-T trials enrolled patients who were either taxane-naïve or who had been treated with a taxane, but were fairly robust. To enroll, patients had to have no or minimal cancer symptoms, no visceral metastases, no regular opioid use, good performance status and organ function, and a washout of three months after prior cytotoxic therapy. Patients who are in earlier stages of disease and fail androgen-deprivation therapy (ADT) possess better innate immunity, which is needed to mount an immune response to this “vaccine.” More robust responses increase the likelihood of extended survival.2,3-5

Table. New and Investigational Therapies for Prostate Cancer

Drug Name Brand Name/Approval Mechanism of Action
Sipuleucel-T Provenge, approved April 29, 2010 An autologous cellular immunotherapy that targets PAP
Denosumab Xgeva, approved June 1, 2010 A monoclonal antibody that binds to RANK ligand, decreasing bone resorption and increasing bone mass and bone strength
Cabazitaxel Jevtana, approved June 17, 2010 A semi-synthetic taxane developed to overcome taxane resistance
Abiraterone acetate Zytiga, approved April 28, 2011 An oral second-generation androgen synthesis-inhibitor that targets the dual-enzyme complex CYP17
MDV3100 Investigational, Medivation, Inc. An irreversible androgen receptor antagonist and androgen receptor signaling inhibitor
Radium-223 chloride Investigational, Ra-223 or Alpharadin, Bayer HealthCare Delivers alpha-particle radiation to the bone and prostate cancer bone metastases

PAP indicates prostatic and phosphatase.

Many urologists are administering sipuleucel-T in the office, an approach that requires good planning and communication with patients. Patients undergo a leukapheresis procedure approximately three days before receiving each sipuleucel-T infusion. Urologists need to stress to patients that punctuality for the leukapheresis procedure and office infusion is essential, since leukapheresis and infusions must be appropriately spaced and sipuleucel-T expires quickly. Patients receive three doses at approximately two-week intervals.3-5


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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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