The approval of Provenge has once again brought to the forefront the very important questions about the proper timing of treatments as well as the issue concerning how to combine therapies to maximize survival. We have, although there numbers are limited, different treatments that are used for the treatment of advanced prostate cancer, but we are at a loss of when is best to use which treatment and can combining any treatment yield an even better survival advantage. Additionally, looking into the near future, we will hopefully be adding a number of additional treatments to our approved list, so where do we place these drugs in the sequence of treatment?
The big, over hanging question is in what order we should use the available treatments and will combining any of these treatments extend survival even longer than when the treatments are used alone, as we do today?
Until the approval of Provenge, Docetaxel plus prednisone (D+P) was the standard treatment for men with castration-resistant prostate cancer (CRPC). Now, we are faced with the question, where in the treatment order do we use new drugs (i.e. provenge) and if we combine them with other treatments, new and existing, will it extend survival even longer?
A small phase I trial performed by Figg et al. combined D+P with different doses of ketoconazole (Keto), an unapproved drug often used