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How Is Chemotherapy Used To Treat Prostate Cancer?

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Published on January 25, 2018

When is it appropriate to use chemotherapy for prostate cancer? Prostate cancer expert Dr. Celestia Higano, from Seattle Cancer Care Alliance, discusses the conditions for its use, and explains which chemotherapy drugs are used for a prostate cancer treatment regimen. Dr. Higano also touches on the role of vaccine therapy for prostate cancer patients.

This is a Patient Empowerment Network program produced by Patient Power in partnership with Seattle Cancer Care Alliance. We thank Astellas and Sanofi for their support.

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Transcript | How Is Chemotherapy Used for Prostate Cancer?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jeff Folloder:              

In some cases, is it appropriate to use chemotherapy in advanced prostate cancer? 

Dr. Higano:                

Yes, also—well, again, I just want to specify—when you say “advanced,” we mean “metastatic.”

Jeff Folloder:              

Understood.

Dr. Higano:                

So, if we just operate on that assumption—because again, “advanced” is used in all kinds of different settings, and I don’t want any misunderstandings. So, yes –in 1990, one of our colleagues wrote a review paper about all the treatments available for metastatic.

At that time, we were calling it “hormone refractory prostate cancer.” There was a very non-prescient sentence in there saying that there’s no role for chemotherapy in prostate cancer. But, luckily, as time went on, we found out that actually, there is a role for chemotherapy in the so-called “metastatic castration-resistant” setting, or “hormone refractory”—whatever terminology you like to use—in that docetaxel (Taxotere) was found to result in improved survival. 

So, docetaxel, for many years, was the chemotherapy we went to when we needed to use chemotherapy for metastatic CRPC, castration-resistant prostate cancer. Then, we learned that cabazitaxel (Jevtana), which is related to docetaxel, is also life-extending when a person needs something after docetaxel.

So, there are two well-studied chemotherapy drugs in the metastatic CRPC setting. But, more recently, we’ve learned that if we move docetaxel up—so, if a patient presents with metastatic prostate cancer and is starting the hormone therapies we’ve just discussed, if you add six cycles of docetaxel to that chemotherapy, patients who got the chemo seemed to live longer than those who didn’t get the chemo early on. Now, there are some issues with that. It’s not necessarily for everybody, but it’s now being used in an earlier setting.

Jeff Folloder:              

Understood. What about vaccine therapy? To me, this sounds really exciting. I can go get a vaccine injection and I’m done.

Dr. Higano:                

Well, the vaccines are therapeutic, not necessarily preventive—at least, theoretically – although, in the case of the one vaccine that we have that Tom and I have worked on for a number of years—even before it was approved—Sipuleucel-T, or Provenge, is a treatment that’s given in the setting of metastatic CRPC, but you’re not going to be done, and that’s…= 

Jeff Folloder:              

Darn!

Dr. Higano:                

I know. I wish it was the case. We give it at the appropriate time, and we can talk about that in more detail if you wish, but we give it, and then we go on with the next—we’re expecting to go on to more therapies at that point—at some point in time. But it’s very well-tolerated. It was the first vaccine that was approved for any cancer, believe it or not.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.