Other Proven Treatments - but Less proven than standard 2nd line therapies

Introduction

There is another possible category of proven treatments which for lack of a better name are being called "other" here.  These treatments might be worth HRPC patients investigating further.

These might be treatments with relatively low PSA response rates (as determined by clinical trial(s), using the >50% PSA decline criteria), treatments that have reduced the PSA doubling time or not produced a >50% drop in PSA or treatments that have relatively few patients in studies done to date, but have produced good results in trials. Stable disease would also be consistent with the proven-other category.

Most of the following can be used in various contexts -- perhaps to delay starting cytotoxic chemotherapy or during a break from chemotherapy (intermittent chemotherapy.)

List of Therapies

• Leukine, Leukine/Retinoids, Leukine/Thalidomide and Leukine/Ketoconazole. Discussed here in the context of extending the off period during intermittent chemotherapy, but also potentially useful in delaying the start of chemotherapy.

• Somatostatin analogs (Sandostatin LAR). The combination of a somatostatin analog with either dexamethasone or an estrogen looks promising as an off chemotherapy option, although data is limited. Possible use as a 2nd-line hormone therapy.

• Ketoconazole/dutasteride(Avodart). Some benefit has been seen when ketoconazole is failing by adding dutasteride.

• Nilandron (nilutamide).  This is normally an antiandrogen used with combined hormone therapy -- as a part of 1st line hormone therapy.  It can also be used as a part of 2nd line hormone therapy.  

• Revlimid (lenalidomide). This "improved" thalidomide doesn't have the peripheral neuropathy or the sedative side effects of thalidomide, but does cause thrombocytopenia in some. This paper has tables giving the results of combining Revlimid with ketoconazole, leukine and with taxotere (docetaxel).

• Suntinib (Sutent).  Sunitinib malate (SUTENT®) is a small-molecule, oral, multitargeted tyrosine kinase inhibitor of VEGFRs (1,2 and 3), PDGFRs (α and β), KIT, RET and FLT3.  Of these, VEGFR overexpression contributes to prostate cancer progression, while PDGFR overexpression is related to bone metastasis progression. Sunitinib is being studied by itself as an HRPC treatment and in combination with taxotere - as a 1st line chemotherapy and as a 2nd line chemotherapy.

• Degarelix (Firmagon). This is a GnRH antagonist that could replace drugs like Lupron for suppressing testosterone and hence PSA in hormone sensitive patients. It has been shown to be effective as a 2nd line hormonal therapy as well. FDA approved for PCa.

Author: Howard Hansen, updated 11/29/08 and 16 July 2010