Provenge Vaccine Update

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Drums
Regular Member


Date Joined Mar 2010
Total Posts : 134
   Posted 7/29/2010 7:27 AM (GMT -6)   
Saw this update on Provenge today.
 

Bloomberg News (7/28, Randall) reported, "Dendreon Corp.'s prostate cancer vaccine, Provenge, extended lives by 4.1 months," a discovery that "led to the drug's US approval in April." Even though the scientific community still doesn't "know precisely how the vaccine works or who is most likely to benefit," Harvard researchers explained that "Provenge is the first drug designed to train the body's immune system to fight cancer and is the most effective treatment for certain patients with advanced prostate tumors."

        The "active cellular immunotherapy," also known as sipuleucel-T, "consists of the patient's own peripheral-blood mononuclear cells, including antigen-presenting cells, that have been activated outside the body using an engineered protein called PA2024," MedPage Today (7/28, Smith) reported. The "protein is a fusion of prostatic acid phosphatase, a prostate antigen, and granulocyte-macrophage colony-stimulating factor, which activates immune cells." Scientists tested its efficacy by randomizing 512 men to either sipuleucel-T or a placebo, which "consisted of peripheral-blood mononuclear cells that were not activated."

        Investigators eventually noted that the "average survival was 25.8 months for men in the Provenge group, compared with 21.7 months for men in the placebo group, meaning that Provenge extended survival by 22 to 25 percent," HealthDay (7/28, Reinberg) reported. "If the vaccine was used by men with less severe disease survival, it might be extended for even longer," and "compared with other treatments, such as chemotherapy, radiation and hormone therapy, Provenge has been touted as having fewer and less severe side effects," according to the study published in the New England Journal of Medicine. "However, the availability and cost of Provenge are issues that need to be resolved."

        The "current cost of care for men with prostate cancer has been estimated at around $1,800 per month," Medscape (7/28, Chustecka) reported. The "vaccine costs $93,000, which works out at $23,000 per month of survival advantage." Meanwhile, the author of an accompanying editorial pointed out that, while the "improvement in overall survival seen is 'important,' the lack of any measurable antitumor effect was 'surprising.'" It also, noted Dan Longo, MD, "raises the concern that the results could have been influenced by an unmeasured prognostic variable that was accidentally imbalanced in the study-group assignments."

<!--{story3}-->
Age 52 at diagnosis, father died of PCa
 
PSA: 10/16/09 - 2.8; 1/11/10 - 3.8
Biopsy 11/25/09, 11 core samples - HG PIN on right side
Biopsy 2/17/10, 11 core samples - left side, adenocarcinoma, Gleason 6, one core at 5%
Notified of dx on 3/12/10 (27th wedding anniversary) via phone by the nurse! (dropped this Uro!)
MRI 3/17/10 and bone scan, 3/23/10, indicate: gland volume is 27mL, PCa is confined to prostate, seminal vesicles and vas deferens are unremarkable.
 
RALP conducted 19 May 2010 by Dr. Lee at U. Penn Presbyterian
Pathology report on 10 Jun 2010: Gleason 6; gland involvement by carcinoma < 2%; tumor in peripheral zone on BOTH sides; no capsular, extracapsular extension, lymph node, or seminal vesical involvement; and no positive margins.
 
Incontinence: first four days after catheter removal - only1-3 pads/day (but urethra was inflammed); 2d week (after inflammation) - 8-10 pads/day (sometimes more!); 3d week - 4-6 pads; 4th and 5th weeks - 3-4 pads; 6th week down to 2 pads. Of course, all this depends on how much I stand and it gets worse later in the day.
 
ED: started the pump the 4th week after the catheter removal. Four sets, twice a day per instructions. Not as fun as it sounded.


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/29/2010 2:29 PM (GMT -6)   
A competitor is in trials right now DCVax, maybe competition will be coming soon enough.
Youth is wasted on the Young-(W.C. Fields)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/29/2010 3:34 PM (GMT -6)   
Still haven't decided if it really is a good investment. Don't get me wrong, it's not that I don't value my life, but an average ( I know about averages ) of 4 months in my opinion is questionable.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01


tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 487
   Posted 7/30/2010 8:07 AM (GMT -6)   
The key statement was "If the vaccine was used by men with less severe disease survival, it might be extended for even longer". I believe that Provenge, and perhaps other coming treatments that are similar, will be more effective and more durable in earlier disease stage. I wish I could use it now while in an off-ADT period in order to extend the time free of further treatments. Nearly all treatments are more effective at earlier stages of disease and with the nearly non existent side effects Provenge would be the best option for men at my stage. I do not expect it to become approved for such use for a long time to come. The demand, and profits, for use in CRPCa will maintain the company for years. Perhaps the wealthy may try it earlier.

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 7/30/2010 1:26 PM (GMT -6)   
goodlife:  The advantage of Provenge is not only for the possible 4 month extension but also for the other 24 months that you would be doing chemotherapy(that's the amount of average time a person survives on chemo).  We all know the terrible side effects attributed to chemo, Provenge supposedly doesn't have them so not only are you extending your life but your QOL will be significantly better than the chemo treatment.
 
It's still expensive but I'd appreciate 28 months of decent QOL compared to 24 of chemo.
 
David
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.
 
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