New prostate cancer agents extend survival, address unmet needs

The approval of four new drugs used in the management of men with advanced prostate cancer is rapidly changing-and improving-the care of these patients. In this interview, Daniel P. Petrylak, MD, explains the role of new first- and second-line therapies, how they address previously unmet needs, and their associated side effects. Dr. Petrylak is professor of medicine, director of genitourinary oncology, and co-director of the Prostate Cancer Program at the Herbert Irving Cancer Center at Columbia University Medical Center, New York. He was interviewed by Urology Times Editorial Consultant J. Brantley Thrasher, MD, professor and chair of urology at the University of Kansas Medical Center, Kansas City.

Q. Cabazitaxel, denosumab, and sipuleucel-T all were FDA-approved for the treatment of men with advanced prostate cancer in 2010, and abiraterone was approved earlier this year. How does this change the care of our patients with advanced prostate cancer?

A. Instead of having one drug that improves survival, we now have more options to treat our patients with castration-resistant prostate cancer.

Sipuleucel-T (Provenge) is a form of immunotherapy that is a dendritic cell product harvested from the patient's own dendritic cells. It shows an improvement in survival of about 4.1 months in men who are minimally symptomatic or asymptomatic, and is not indicated for those with visceral disease. This treatment is positioned prior to chemotherapy.

Abiraterone acetate (ZYTIGA), which knocks out testosterone completely, shows a survival benefit post-docetaxel. There are some other studies that are looking into using this drug prior to docetaxel.