- Paladin Longview

Promising Treatment Options for African American
Men with Advanced Prostate Cancer
Recorded on: May 29, 2012
David Ian Quinn, MBBS, PhD, FRACP
Medical Director
Norris Cancer Hospital and Clinics
Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, 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.
African American men are disproportionately affected by prostate cancer, and their death rate is
higher than Caucasians. Dr. David Ian Quinn led an analysis of how African American men with
metastatic castrate-resistant prostate cancer responded to a new active immunotherapy, Provenge
(sipuleucel-T). An analysis of three phase III trials, presented at the 2012 meeting of the American
Urological Associate (AUA), confirmed that African American men responded to the “anti-cancer
vaccine” and suggested they might even do better with it than Caucasians.
What does your data analysis show regarding African American men with advanced prostate cancer
and their overall survival?
Dr. Quinn:
So, active cellular immunotherapy, something called sipuleucel-T or with a brand name Provenge,
is a relatively new therapy. We’ve had it approved for almost two years. And we’re now looking at
the data that has been accumulated over a series of trials to see whether there are particular
patients who might benefit more or less from the therapy. And from that perspective the analysis
that we have presented here at the AUA (American Urological Association) meeting in Atlanta looks
at a variety of different things, most particularly how African American men do with this treatment
compared to other patients.
Now, the finding that is salient to this is that African American patients seem to benefit at least as
much and probably more as a subset from having immunotherapy for their advanced metastatic
prostate cancer than Caucasian men who are the predominant people who went on the trial. What
is in this particular presentation is an attempt to look at why African American men do better, and
in that regard we have some parameters of immune response in those patients that we’re
examining that are as good and potentially better than we see in Caucasian men.
We’re not exactly sure why this occurs. African American men may have an immune system that’s
better attuned to this therapy and therefore may do better and have a slightly better immune
response. Or there may have been a selection in the trials so that the African American men that
opted to go on this trial and the other trials that were analyzed looking at this therapy may actually
have done so because they selected themselves out to go on that therapy. They may have had a
better understanding of their disease, they may have been more amenable to the trial, and that
may have meant that they’re better than the average Joe that would have gone on. But I think
these data are interesting and hopefully represent some good news for the African American
population with prostate cancer.
What are the benefits of this treatment for African American men?
Dr. Quinn:
I think what it means for African American men is that the newer therapies that are coming to
prostate cancer are a benefit to them, and there’s always this doubt. Getting African American
men to go into clinical trials is a challenge. There’s a lamentable history in this country with what’s
occurred with medical research and what I would describe as experimentation in African
Americans, and certainly our African American friends are very well educated as to that, and from
that perspective getting the African American population to be involved in trials is a major
challenge and one that we’re trying to address at USC as well as at other centers around the
But from that perspective, African American patients will come to us and say, well, look, I’m
different to you. I have a different colored skin, my metabolism might be different, my cancer
might be different. It certainly seems like it’s more aggressive than what a white guy gets. And
I’ll say yeah. Then I’ll say, well, how do African American patients do on this therapy, and from
that perspective we’re now able to say to them, look, you’ll do as well as the white guy, and the
good news is that your immune system or something may mean that you do better, and it’s worth
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therefore you trying this because you have a disease that has reached a certain stage where it’s
going to be fatal, and this has the opportunity to extend your survival.
How could this change the overall treatment approach for African American with castrate-resistant
prostate cancer?
Dr. Quinn:
For the patients with metastatic castrate-resistant prostate cancer we now have a plethora of new
drugs. Active cellular immunotherapy, of which Provenge (sipuleucel-T) is the first product and
hopefully not the last immunotherapy that we’ll have, should be given early in the course of the
disease. There’s a window where we need to give it to men early, very soon after they develop
castrate-resistant prostate cancer for them to get a benefit.
The reason for this is that immunotherapy is a little bit different. It doesn’t produce an
instantaneous result, and its results in an individual patient can be difficult to meter. For example
very few patients get any sort of PSA response or change when we give them Provenge
(sipuleucel-T) therapy. But what we know is that after they’ve had the therapy, which is priming
the immune system—it’s sort of like a vaccine—that the longer they survive after that, survivals
after one and two years, they start to benefit with an extension in their survival. And we will see
other data in the next few weeks about selecting patients early in their castrate-resistant disease
to go on this therapy where the benefit may be maximized.
What are some other promising therapies?
Dr. Quinn:
Having seen this data related to Provenge (sipuleucel-T) we’re now looking in the Southwest
Oncology Group to examine patients who have gone on a series of trials over the last 20 years with
what’s called SWOG, Southwest Oncology Group, to look at response, and it appears that African
American patients may actually do a little better than their White colleagues with chemotherapy as
well. Now, we need to look at that and place it in the context of initial hormone therapy, androgen
deprivation, to see whether they’re benefitting in particular ways, and this will allow us to refine
the therapy.
The data from a series of newer agents is going to be very interesting. We’re waiting on data with
a new hormonal agent called ZYTIGA (abiraterone acetate) in African American patients, and my
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understanding is that we will not see that here, but in the next few months we’ll see that. And
with a new drug called Medivation 3100, a new hormonal agent also, we will see some data.
There is a liquid radiation called Alpharadin (radium-223 chloride). We’ve seen the first of those
results early in this year, 2012, and we’ll see more data in the next few weeks on that.
Unfortunately, that study accrued mainly in Europe because we were slow to get it started here
and the Europeans realized it had great potential and therefore not too many African Americans or
in fact other minorities outside of Caucasian folks went on that. But that’s a very powerful therapy
directed at one part of the bone metastasis and cancer that lies within that.
And I think from that perspective we’re going to be looking to move these therapies forward and
to—as they get registered with the FDA—look at the experience in minorities to see whether there’s
good effect. We think there will be, there’s no reason why there shouldn’t be, but also to look at
the side effects and how they’re tolerated and whether there’s an issue with durability of the
response as well in not just African American patients but also Hispanics and in Asian Americans.
Are you encouraged?
Dr. Quinn:
Absolutely. I think we’ve learned a lot in the last certainly three years but I think in the last
decade. What we’re seeing now is the result of investment from the research community, from
NCI (National Cancer Institute), from a series of pharmaceutical companies, and we’re starting to
get new treatments. What we need to do now is to work out the sequence and combination of
these treatments and whether there are particular individuals that might benefit from one of these
treatments or from all of them or from none of them and to look at new strategies. And I think we
need to cut up our research that we’ve invested in and try to look for patterns.
The other issue relates to how we apply our research, and I think that we have a commitment at
USC and at the Southwest Oncology Group that the research we do needs to be applicable and
available right across the spectrum of our community. And our focus in this presentation that we
have here at AUA (American Urological Association) is obviously African American patients. If we
look at the socioeconomic levels in this country, we know that the educated patients and the ones
that have means are the ones that are doing well, regardless of the ethnicity, will access these
therapies, and they will be, in quotes, early adopters.
What we need to do is to make sure that right down in what we call the sixth and seventh echelons
of socioeconomic level we make this available, and so we’ve made some decisions at USC where
we have two clinical facilities. We have the Norris Cancer Center where we see predominantly
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patients that have insurance and Medicare, and then the largest indigent population in California at
the Los Angeles County USC Medical Center. And the Norris (USC Norris Comprehensive Cancer
Center) and Keck (Keck Medical Center of USC) hospitals have made the decision that we will offer
Provenge (sipuleucel-T) therapy to appropriate patients who would otherwise not be able to access
it within the Los Angeles County system. And we’re working with the company that makes
Provenge (sipuleucel-T) to ensure that that’s accessible for them at zero cost and that we try and
get the benefit of the last three to 10 years research to everybody in the community, not just those
who can pay for it.
Is this a more hopeful time?
Dr. Quinn:
Yes. I think it is a very hopeful time. It’s a very positive time. We’ve had a lot of developments in
a very short time, and that challenges those of us who are in medical research. And what I’d say is
that we need to work out the optimal application of these drugs. We’ve done a series of probably
between 12 and 20 critical trials, and we’ve had great support from patients. We really need to be
very respectful that we’ve done this at the end of the prostate cancer spectrum and that most of
the patients who went on those trials are dead, and so we’ve been batting at the end.
And I would encourage patients to look at trials that offer these therapies earlier, particularly
immunotherapy where the longer you get vaccinated for and the longer you’re alive with that
immunotherapy response in your immune system working against your cancer, likely the better
you do. I would encourage patients to consider those trials carefully and to try and be involved in
as much as they can.
We also do ancillary trials looking at people’s cancer and also their immune system and other
factors that teach us a lot. And what we’re going to see now is some of those data come through
and inform us about where we should be going with the therapies. And I think that’s the real hope.
At the moment we get trials that extend life by a few months at the end. That’s very important, I
think provides quality time for those patients. If we can get things moving a little earlier then we
continue on the pathway of maximizing that and also providing a hope for cure.
Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, 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.
В© 2012 Patient Power, LLC