Can You Combine Provenge with Xtandi?

Treatments for castrate resistant prostate cancer have only been studied individually for the most part, but a case report published in the journal Urology begins to shed some light on whether combining Provenge with Xtandi might have benefit for some patients with castrate resistant prostate cancer .

Nearly 1 in 3 men treated with local therapy for prostate cancer will experience a relapse and most will be treated with androgen-deprivation therapy.

A case report is a detailed report of one patient’s experience with symptoms, diagnosis, treatment, or response. One cannot base care for large groups of patients based on this type of medical data, but it may provide a basis for future research.

One Patient’s Experience Combining Provenge with Xtandi

This particular patient had an initial successful treatment with Xtandi. Prostate-specific antigen (PSA) levels became undetectable, but began to rise after approximately 14 months. The patient elected to combine  Provenge with Xtandi therapies. The patient had another complete PSA response after approximately 6 months.

In addition, the patient had also been treated with and responded to granulocyte-macrophage colony stimulating factor (GM-CSF). The authors hypothesize that previous clinical response to GM-CSF may predict future response to Provenge. Further, the authors discuss basic science studies that indicate Xtandi  treatment may augment a patient’s response to Provenge. The authors go on to say that because Xtandi does not require use of steroids, an immune suppressant that can affect vaccine response, combining Provenge with Xtandi may be an optimal choice for combination therapy.

Standard oncology practice often utilizes multiple drugs with different mechanisms of action in order to attempt to achieve a treatment benefit. The idea is to attack the cancer from different angles. Provenge is an immunotherapy and thus it offers a different mechanism of action from Xtandi. As a result there is a scientific interest in combining Provenge with Xtandi.

Future Study Combining Provenge with Xtandi

According to a press release at the 2013 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO), Dendreon (the company that makes Provenge) has named a steering committee for a Phase II trial for sequencing Provenge with Xtandi. The study plans to begin enrolling patients in late 2013.

If you think that you might be a candidate or would like to consider combining Provenge with Xtandi, you need to talk with your doctor. Some insurance companies tightly regulate the use of both Provenge and Xtandia. Your insurance company may require your doctor to follow a certain pathway or order in which cancer drugs are used.

Sources

Enock Anassi, MD, PharmD; and Uche Anadu Ndefo, PharmD, BCPS. Sipuleucel-T (Provenge) Injection: The First Immunotherapy Agent (Vaccine) For Hormone-Refractory Prostate Cancer. Pharmacy and Therapeutics  Vol. 36 No. 4 . April 2011

National Cancer Institute. Enzalutamide. Accessed June 13, 2013.


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