I have heard some occasional discussion that once (that is if) enzalutamide (MDV-3100) is approved by the FDA for the treatment of men with advanced prostate cancer, it will over shadow Provenge. On the contrary, I believe that the approval of enzalutamide will actually encourage additional use of Provenge resulting in the increasing use of Provenge as a standard treatment.
It is my belief that doctors will use these treatments in combination. With most cancer treatments the rule to good treatment practice is to combine treatments, something that is currently lacking in the treatment of men with advanced prostate cancer.
Since Provenge and enzalutamide have two completely different mechanisms of action (MOA) to not take advantage of this makes no sense. Provenge cannot be combined with Zytiga because Zytiga requires the use of concurrent steroids. Steroids tear down the immune system and Provenge is designed to enhance the immune system.
So, my prediction is that once enzalutamide is approved the better doctors will quickly move in the direction of quickly putting their patients with advanced prostate cancer on the combination treatment of Provenge and enzalutamide.
Now, we have to wait for the approval of enzalutamide to see if I am correct.
Joel T. Nowak, M.A., M.S.W.
what is your opinion about ProstVac?
doesn’t it seem potentially better than Provenge, also – easier to make, and thus probably cheaper?
overall survival advantage looks promissing from initial reports
I agree 100%. I have had Provenge and I am stable. To recap I have I presented with Gleason 9(4+5) prostate cancer metastatic to the bones 7/09. Three months after starting ADT I underwent chemo with Taxitere and Carboplatin. In 2/09 I was lucky enough to get Provenge and the insurance covered. I have been stable. I would annoy my oncologist to give me Zytega but we are worried about the need for Prenisone. I am hoping that she will give me MDX3100 when it gets improved. I would try Alpharadon when it gets approved but I have minimal pain and my oncologis has hematological concerns.
She did give metformin 500 mg bid off-label and I take a statin off lable. I also take my POM-X and tumeric acid.
As both a patient and urologist I think for the moment in time the best outcomes will be with combination therapy. The obvious question when and which medications. Having had chemotherapy, Provenge and metformin off-label and the succes is difficult to measure other than I have one better than the statitics for the moment.
Keep up the good work!
Mrc
Error got chemo 2/10 and Provenge 2/11. Time flies when you are having fun.
Marc
How many men are wasting months and months post provenge as their PSAs increase with mets increasing waiting for it to “work”. Provenge is delaying treatment. Talk about deceit.
We do not yet have the Prostvac numbers, but the reports we hear are great. Once it is approved, if approved, we will have to figure out if it is better to use it as an alternative to Provenge, or better to combine it with Provenge. – Joel
Sue, This is your opinion, the statistics tell a different story.
Joel
Hi Joel, my dad has metastatic prostate cancer and has just been approved for Provenge. As a miracle, he also got approved to receive early access to MDV3100. His PSA level is very high, and I’m getting very concerned about how fast things are getting worse (as far as pain). In your opinion, can he go ahead and be on these two medications at the same time? Are there added risks? Or, is it better to be on one first then add the other? With a rising PSA of 500+, which medicine would be most beneficial to extend his life the longest?
Anna – This is an excellent. First, I urge you to talk with your Dad’s doctor about which is the best option at this time.
1- There has never been any test combining Provenge with MDV-3100, so it is impossible to give you an answer. I will say that many of us believe that they might be an excellent combination since they will probably not conflict with each other (The MDV-3100 does not require a steroid). However, nobody knows until they are tried the combination in a formal clinical trial. So, I can not recommend that you combine the two treatments.
2- If your Dad’s PSA is already 500 and rising I would personally be afraid of going the Provenge route. Provenge will not control his PSA which will probably continue to increase during the month long treatment. Not withstanding this, if he thinks that he could tolerate the months wait and not “freak out” about his rising PSA then he could consider Provenge. PSA has not been shown to relate to survival time, but with numbers that hi, I would become concerned. I personally could not tolerate that high a PSA.
3- I find it hard to believe that either party would allow you to take both treatments at the same time. We have no way of knowing what effects either of the treatments would have if taken together. The only way to get both would be not to tell the other that you are receiving the other treatment, a dangerous and not wise idea which I urge you not to do.
4- Provenge has only been tested for men with minimal or no symptoms. It sounds as if your Dad does not meet this criteria.
I hope this has been helpful. Do not take both by not letting the other know about the second treatment. Speak to your doctor about the risks he might incur by having Provenge with a PSA of 500 that is increasing.
Joel
Tulane Univ. in New Orleans is starting Provange & MDV-3100 Trials at this time.
I appear to be very similar to Marc Nierman. January 2010, metastaic to the bone, Gleason 9($+5). ADT but no chemo, ADT losing effectiveness 06/2011. Provenge 08/2011, then a clinical trial for MDV-3100, but I appear to have been on the placebo (I hope), so on ketaconozole for a couple of months. Started Zytiga 06/2012. No pain to speak of, so not eligible for alpharadon trial. Hope to get it and MDV-3100 when approved.