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    Guidelines update: Bladder, kidney, prostate cancer

    Recent statements reflect rapid pace of diagnostic, treatment advances


    Immunotherapy for treatment of prostate carcinoma (Society for Immunotherapy of Cancer)

    James L. Gulley, MD, PhDDr. GulleyThe Society for Immunotherapy of Cancer’s consensus 2016 statement on immunotherapy for the treatment of prostate carcinoma provides a framework to inform clinicians about which patients are most appropriate for immunotherapy and which patients are not appropriate for such a treatment path, says James L. Gulley, MD, PhD, director of the Medical Oncology Service with the National Institutes for Health’s Center for Cancer Research, who contributed to the consensus statement. The consensus statement was published in the Journal for ImmunoTherapy of Cancer (2016; 4:92).

    Still, Dr. Gulley points out that the consensus statement doesn’t say specifically which immunotherapy will work for individual patients. Rather, it provides guidance for the type of patients that he and other prostate cancer experts believe are most likely to benefit. Thus, not every patient is going to be an appropriate candidate for immunotherapy, he says.

    According to the consensus statement, immunotherapy is indicated for metastatic castration-prone cancer in patients with minimal or no symptoms. After reviewing the available studies, the experts found that the quartile of patients who received sipuleucel-T (Provenge) versus placebo earliest in the disease process lived an average of 13 months longer and experienced a 50% decrease in the chance of death. Patients in more advanced stages of the disease who received sipuleucel-T versus placebo gained an increase of 2 months and experienced a 20% reduction in the chance of death.

    As a group, the consensus panel experts state a reluctance to treat patients with rapidly progressing disease or significant visceral disease, such as liver metastasis. That’s because there was no dramatic decrease in the volume of the tumor or a decrease in prostatic ductal adenocarcinoma with sipuleucel-T treatment. Dr. Gulley says that’s likely because of the long-term effect of developing an adequate immune response during earlier stages of the disease. If clinicians believe they will run into problems earlier clinically, then they should pursue other treatments; a plurality of the experts said they would use agents like enzalutamide (XTANDI) in addition to sipuleucel-T, according to Dr. Gulley.


    Disclosures: Full disclosure of the guideline and consensus panel members’ conflicts of interest is provided in the published versions of the statements: bit.ly/NMIBCstatement, bit.ly/Renalmassesstatement, bit.ly/RCCimmunotherapy, and bit.ly/PCaimmunotherapy.

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    Aine Cryts
    Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, ...


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