I have said many times that one of the more important issues facing our use of Provenge is when to start it and how to sequence this treatment with the other newly approved agents that have recently become available for men with advanced prostate cancer. There is occasional conversation that Provenge is already antiquated due to the approvals of Zytiga (abiraterone) and Xtandi (MDV31000), but this is not true!

Looking at oncology in general, the sequencing of treatments and the co-administration of treatments is very much the norm and there is no reason to believe that this should be any different in treating men with advanced prostate cancer. Provenge is not antiquated, but we need to find the proper scheduling of all our new treatments.

In the strange but real events in the treatment of prostate cancer, Zytiga is often used instead of Provenge, despite the fact that Zytiga failed to extend survival (COU-AA-302). What probably makes more sense that in men where their disease load is still small and not growing quickly the better first drug is Provenge.

According to The Journal of Clinical Oncology:

“The practical dilemma of the appropriate sequence of use of the two new noncytotoxic agents (sipuleucel-T and abiraterone) is being addressed by trials that are under development. For now, given the broader window of