Immunotherapy for Castration Resistant Prostate Cancer
Daniel P. Petrylak, MD, presented “Immunotherapy for Castration Resistant Prostate Cancer” during the 19th Annual Future Directions in Urology Symposium on August 11, 2018 in Colorado Springs, Colorado.
How to cite: Petrylak, Daniel P.. “Immunotherapy for Castration Resistant Prostate Cancer” August 11, 2018. Accessed [date today]. https://grandroundsinurology.com/immunotherapy-for-castration-resistant-prostate-cancer/
Immunotherapy for Castration Resistant Prostate Cancer – Summary:
Daniel P. Petrylak, MD, provides a brief update on data regarding sipuleucel-T for castration resistant prostate cancer (CRPC), as well as pembrolizumab for microsatellite instability (MSI) -high metastatic prostate cancer patients.
Sipuleucel-T for Castration Resistant Prostate Cancer (CRPC)
Data shows that while sipuleucel-T provides a 4 month improvement in survival to CRPC patients, the drug does not show improvements in PSA levels, soft tissue disease, or bone scans. This phenomenon may be related to a delayed action from the immune system or interaction with treatments following sipuleucel-T. However, additional evidence suggests giving sipuleucel-T early in the course of CRPC may provide a survival benefit. Further studies are necessary in order to provide a definitive explanation for this phenomenon.
Checkpoint Inhibitors for Metastatic Prostate Cancer
Emerging data suggests that about 2% of patients with metastatic prostate cancer are also MSI-high. These patients are therefore suitable for treatment with pembrolizumab. The FDA recently approved pembrolizumab for MSI-high cancers originating in any location of the body. A confirmatory trial by De Bono et al. demonstrated that pembrolizumab has an ~11% higher response rate in patients with DNA repair mutations.
Overall, urologists need to better understand molecular markers, particularly MSI markers, for prostate cancer to select patients eligible for immunotherapy. Ongoing trials will provide further analysis of markers involved in prostate cancer immune response.
About Dr. Petrylak
Dr. Petrylak is the Professor of Urology and Medicine at the Smilow Cancer Hospital at Yale University. He has expertise in the research and development of new drugs and treatments, especially immunotherapies and checkpoint inhibitors, to fight prostate cancer.
About the Future Directions in Urology Symposium
The Future Directions in Urology Symposium (FDUS) is an annual collaborative meeting with a faculty consisting of the top researchers, physicians, and educators in the field of urology. During FDUS, experts provide updates on recent developments and debate innovative management approaches in genitourinary cancers and urologic conditions. Subsequently, the experts devise consensus statements in accordance with the discussions held in the meeting.
In this video, Dr. Petrylak discloses the thesis of the discussion he led during FDUS.
ABOUT THE AUTHOR
Daniel P. Petrylak, MD, leads the genitourinary cancers medical oncology team at Smilow Cancer Hospital as director of the genitourinary cancer research group, professor, and co-director of the Cancer Signaling Network program. Dr. Petrylak joined Yale from Herbert Irving Cancer Center at Columbia University Medical Center with New York-Presbyterian Hospital, where he served as Professor of Medicine (Medical Oncology) and Urology and began his appointment in September of 2012. Dr. Petrylak is a member of the American Association for Cancer Research (AACR), American Society for Clinical Oncology (ASCO), American College of Physicians (ACP), American Association for the Advancement of Science (AAAS), American Urological Association (AUA), and the Southwest Oncology Group (SWOG). After serving for more than 20 years as the advanced bladder chair for SWOG, Dr. Petrylak is now the Vice Chair of the Genitourinary Committee. He additionally has led multiple national and international studies in prostate and bladder cancer.
Dr. Petrylak’s research interests span both prostate and bladder cancer. He led an investigator-initiated trial of docetaxel and estramustine in castration resistant prostate cancer. The results of this study supported a phase 3 trial of this combination in SWOG led by Dr. Petrylak, which in turn, supported the FDA approval of docetaxel for castration resistant prostate cancer. This was one of the first two trials to demonstrate a survival benefit in this state of disease. Dr. Petrylak has also been instrumental in the development of immunotherapy and targeted therapies for refractory bladder cancer. His work with Enfortumab Vedotin has supported the accelerated and full FDA approval of this drug.
Dr. Petrylak received his undergraduate degree from Columbia College and his medical degree from Case Western University School of Medicine. He completed his internship and residency at Albert Einstein College of Medicine and his fellowship in medical oncology at Memorial Sloan-Kettering Cancer Center. He has authored more than 200 peer-reviewed articles and book chapters on prostate and bladder cancer research outcomes.
