SITC Guidelines Bundle

Immunotherapy for Prostate Carcinoma

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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.

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