In a newly published article on the STAT web site, two clinicians at Oregon Health and Science University argue that the benefits of immunotherapy in the treatment of cancer are being greatly over-“hyped”.
The article by Gay and Prasad is entitled “Few people actually benefit from ‘breakthrough’ cancer immunotherapy“, and there is some justification for their perspective. We suggest that you read the article for yourselves.
The authors, however, do not include prostate cancer in the list of forms of cancer for which immunotherapeutic “drugs” are approved by the US Food and Drug Administration (FDA). Strictly speaking, they are correct, sipuleucel-T (Provenge) is not a “drug”; rather, it is a form of biological therapy. However, since it is an FDA-approved form of “biological therapy” one might want to feel that the authors are splitting hairs.
On the other hand, of course, the authors would probably still, and with justification, argue that it is only the minority of patients treated with sipleucel-T who show striking responses to this type of therapy. For many patients there is little to no benefit although there are significant costs and distinct risks for adverse effects of treatment.
Having said all of this, however, the authors are also careful to point out that there is a relatively small subset of patients (of the order of 10 percent) who respond astonishingly well to various types of immunotherapy:
When immunotherapy works, the result is terrific, even life-changing.
The question is going to be if and when and how we are going to be able to identify with accuracy the patients who really have a high likelihood of responding well to specific types of immunotherapy for specific subsets of cancer (and specific subsets of prostate cancer in particular). It may take a while to work out the answer (or answers) to that question.
Filed under: Drugs in development, Living with Prostate Cancer, Management, Treatment | Tagged: efficacy, hype, immunotherapy, safety |
THE "NEW" PROSTATE CANCER INFOLINK 
Hi.
I speak to my oncologist all the time about new treatment possibilities and can usually get a pretty good response from him. He has a clear bias towards chemotherapy but is open minded. He is also an active researcher.
Side effects are an important consideration for me since I already have several permanent side effects from prior treatment which have negatively affected my quality of life. However, I am still alive (it is just not as much fun as it used to be).
Recently we have discussed me taking a trip to Germany to discuss AC-225 PSMA 617 radioligand treatment. He is not completely comfortable but has endorsed me going to Germany at least for a scan and consultation. Many of us have read the Brief Communication which outlined the excellent response of 2 patients (out of a total of 80). Very exciting but also may fall into the category of hype. I believe that 75% of the 80 had some response and most relapsed relatively quickly. However the media focus is on the two excellent responses. Obviously there is a reason for those excellent responses but as yet undocumented.
We have also discussed cabozantinib as a possibility but a long shot based on cost and side effect profile.
We will also re-biopsy my liver, looking for any new somatic actionable anomalies but as the referenced article states finding a immunotherapy that provides an excellent response is a long shot.
The good news is that I have had a PSA response to mitoxantrone, so we will do nothing until the PSAa begins its rise again. At that point I will likely go to Germany. I do consider this treatment option to be a long shot — hype or no hype.
The difficulty is explaining to family and friends the reality associated with the hype they see on TV or in media.
Hype or not, I believe it is important to discuss new developments with your oncologist.
And Bill … I am in 100% agreement with your last two sentences!
Mike