Immunotherapy for castration-resistant prostate cancer
- Philip W Kantoff, MD
Philip W Kantoff, MD
- Section Editor — Testicular Cancer
- Chairman of Medicine
- Memorial Sloan Kettering Cancer Center
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
For men with advanced prostate cancer manifested by either metastases or a rising prostate-specific antigen (PSA) after definitive therapy, androgen deprivation therapy (ADT) usually can provide disease control for a clinically significant period of time. Ultimately however, disease progresses in almost all cases. Patients who progress while on ADT are termed castration resistant. (See "Initial systemic therapy for castration sensitive prostate cancer".)
The use of the dendritic cell vaccine sipuleucel-T and experimental immunotherapies for the management of castration-resistant prostate cancer will be reviewed here. An overview to the approach to systemic therapy, including the role of different treatment options for castration-resistant disease, is presented separately. (See "Overview of the treatment of disseminated prostate cancer".)
Prostate cancer cells express a number of tumor-associated antigens that can serve as targets for immunotherapy. Examples include prostatic acid phosphatase (PAP), prostate-specific antigen (PSA), and prostate-specific membrane antigen (PSMA).
The poor in vivo immune response to many tumors, including prostate cancer, has been attributed to evasion of immune system recognition by decreased immunogenicity of surface antigens or blunted effectiveness of the immune response mounted against them. Several approaches have been studied to circumvent defective presentation of antigen to effector cells and/or enhance the responsiveness of the patient's own immune system. (See "Principles of cancer immunotherapy".)
Autologous dendritic cells can be used to deliver prostate cancer antigens for effective in vivo T cell activation. Dendritic cells, which can be harvested by leukapheresis, are efficient antigen-presenting cells that initiate an antigen-specific immune response via uptake, processing, and presentation of antigens to T cells. Sipuleucel-T, a dendritic cell vaccine that induces immunity against PAP, can prolong overall survival and is commercially available. (See 'Sipuleucel-T' below.)
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