Immunotherapy for Prostate Cancer
Immunotherapy for non-mCRPC
➤ ➤ Based on recent data and accumulated experience with immune activating
agents in patients with prostate cancer, immunotherapy may achieve greater
benefit among mCPRC patients treated earlier in the disease course. (B)
Note: There are currently no efficacy data to support the use of sipuleucel-T in
patients with non-metastatic prostate cancer.
Selec ng Pa ents for Immunotherapy
➤ ➤ There is a role for sipuleucel-T in the management of asymptomatic or
minimally symptomatic patients with mCRPC prior to chemotherapy.
(A with mCRPC)
➤ ➤ To select patients for use of sipuleucel-T:
• Use prostate-specific antigen (PSA), complete blood count (CBC), and liver
enzymes to rule out individuals at risk for rapid disease progression, who would
not be suitable candidates for treatment. (71%)
• Imaging should be used to determine extent of disease in order to decide which
patients are suitable for treatment. (64%)
Notes: The panel recommended using the rate of change at disease sites
by imaging, reflecting the pace of the disease, to determine whether
immunotherapy is appropriate. Patients with rapidly growing disease should not
receive immunotherapy. Similarly, the panel would exclude patients with liver
metastases.
Cor costeroid Therapy, Chemotherapy, and Secondary Hormonal
Agents
➤ ➤ For corticosteroid doses equivalent to ≤10mg/day prednisone, it is not
necessary to wean corticosteroids in order to treat with sipuleucel-T. (100%)
➤ ➤ Patients who have been treated with abiraterone/corticosteroids for ≥6
months, and are taking physiologic doses of glucocorticoids, can proceed with
sipuleucel-T. (B)
There are no data to suggest that corticosteroids have an impact on clinical
outcomes following treatment with sipuleucel-T.