Why do African Americans do better on Provenge than whites?


In general, being of African American race is not a good thing when it comes to prostate cancer-related risk (for getting diagnosed with the disease or for outcomes over time). However, …

At the American Urological Association annual meeting earlier this year, Sartor et al. presented data that seemed to clearly indicate one strong exception to that general rule.

They were able to use data from the PROCEED registry of men being treated with sipuleucel-T (Provenge) to show that men of African American race who had  asymptomatic or minimally symptomatic, metastatic, castration-resistant prostate cancer (mCRPC) and who were treated with sipuleucel-T had a much longer average (median) overall survival (OS) than comparable Caucasian (white) patients: 39.5 months for the African Americans as opposed to 28.1 months for the Caucasians, or nearly a year longer on average.

The other things that were also predictive of better outcome among the 420 Caucasian and the 210 African Americans whose data were compared were these:

  • Age (younger men did better than older men)
  • PSA level at time of treatment (men with lower PSA levels did better)
  • Alkaline phosphatase level at time of treatment (men with lower alkP levels did better)
  • Hemoglobin levels at time of treatment (men with higher Hb levels did better)
  • Prior chemotherapy (men who had not had prior chemotherapy did better)

These five other results confirm things we were already pretty sure about, which is a good thing. However, we had only had hints that there might be a benefit to African-American race, and this has now been confirmed too.

Some of the relevant details about the PROCEED registry, this study, its results, and relevant discussion are accessible at the following links:

  • Click here for information about the design of the PROCEED registry
  • Click here for the abstract of the paper presented at the AUA annual meeting.
  • Click here for a video interview with the lead investigator, Dr. Sartor.
  • Click here for Q&A with Dr. Sartor that is similar to the video.

You do need to register with UroToday in order to access the last two of resources, but the information is freely available to the patient community.

So why do African Americans do better on sipuleucel-T than Caucasians? Frankly, as yet, we haven’t a clue. But …

What this study very clearly does show is the importance, for the African American community in particular, of early referral to a medical oncologist when they first show signs of becoming castration-resistant. The early use of Provenge among such patients is clearly highly beneficial.

The other issue that now becomes highly relevant is whether even earlier use of sipuleucel-T among such patients comes with even greater benefits. Should African American men (or indeed any man of historic “black” African ethnicity) with high-risk or metastatic disease actually be getting treatment with sipuleucel-T in combination with androgen deprivation therapy (ADT) as soon as such therapy is shown to be necessary? And might that actually be true for younger white folks with lower PSA levels, lower alkP levels, and higher Hb levels as well?

We are only at the earliest stages of starting to understand the potential of early combination therapy in the treatment of high-risk and advanced forms of prostate cancer, but at least, for once, we now know that there is something that gives you an advantage if you are black and have prostate cancer!

 

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