Practical guide to immunotherapy in castration resistant prostate cancer: the use of sipuleucel-T immunotherapy.
BACKGROUND
New treatment options for metastatic castration resistant prostate cancer (mCRPC) have become available over the last few years should primary treatments and androgen deprivation therapies fail. While historically not considered to be amenable to immunotherapy, the treatment of advanced prostate cancer using this approach is an area of intense interest and now clinical application.


METHODS
Recent literature on castration resistant prostate cancer management with a focus on immunotherapeutic strategies was reviewed. Mechanisms of action involving the immunologic treatment of cancer were identified. Agents in clinical trials with near term application in prostate cancer were also identified.


RESULTS
Numerous immunotherapeutic agents for mCRPC are in current clinical trials. The autologous, active cellular immunotherapy, sipuleucel-T, which utilizes a patient's own antigen-presenting cells, is the only Food and Drug Administration (FDA) approved agent. It provides a 4.1 month survival advantage. Other investigational agents in this area include GVAX, a whole cell irradiated vaccine, and a vaccinia-PSA-TRICOM pox virus based approach, all in phase III trials. Immune-checkpoint inhibitors that enhance T-cell activity and potentiate antitumor effects are also promising.


CONCLUSIONS
A first in class novel treatment modality, sipuleucel-T, is available in the United States for mCRPC. Other immunotherapies are in development and may be available in the near future. Understanding the detailed patient evaluation, initiation and administration of sipuleucel-T as described in this paper, will allow this novel cancer immunotherapy to be better understood and potentially benefit a larger group of appropriately selected patients.
Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Leonard G
LG
Gomella
Francisco
F
Gelpi-Hammerschmidt
Chandan
C
Kundavram
D019496:Cancer Vaccines / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008297:Male; D017410:Practice Guidelines as Topic; D064129:Prostatic Neoplasms, Castration-Resistant / Q000276:immunology / Q000628:therapy*; D014020:Tissue Extracts / Q000627:therapeutic use*; D016896:Treatment Outcome
D019496:Cancer Vaccines; D014020:Tissue Extracts; C511774:sipuleucel-T