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.