Provenge and men with advanced prostate cancer

At the fall meeting, Paul Schellhammer, of Urology of Virginia, presented insights on the immunotherapy Provenge (sipuleucuel-T), leading the group through a perspective on the drug’s path to FDA approval for men with advanced prostate cancer. Schellhammer presented two modern data points from the IMPACT trial and PROCEED registry that give indicators of patient populations that may benefit more from sipuleucel-T. His analysis of baseline PSA levels and corresponding overall survival from the IMPACT trial has been called the “quartile” data. The analysis illustrates a more pronounced survival among men with a PSA less than 22.1ng/ml upon therapy commencement. Additionally, he reviewed data recently presented at the AUA on Provenge use within the African-American population from the PROCEED registry. These data demonstrated a survival benefit of 37.3 mo. vs. 28.0 mo. compared to Caucausian men. This benefit was even more pronounced when looking at below-average PSA levels (54.3 months vs. 33.4 months, respectively).

  • Ref: Lower Baseline Prostate-specific Antigen Is Associated With a Greater Overall Survival Benefit From Sipuleucel-T in the Immunotherapy for Prostate Adenocarcinoma Treatment (IMPACT) Trial. Schellhammer, Paul F. et al. Urology , Volume 81 , Issue 6 , 1297 – 1302
  • Sartor O, et al. Overall Survival Analysis of African American and Caucasian Patients Receiving Sipuleucel-T: Preliminary Data from the PROCEED Registry. Presented at the 2017 American Urological Association (AUA) Annual Meeting; May 13, 2017; Boston, Mass.

New treatment options for bladder and kidney cancers

The Fall 2017 UroGPO meeting highlighted two disease states in which new therapeutic options are rapidly coming to market: bladder cancer (urothelial carcinoma) and kidney cancer (renal cell carcinoma – RCC). In the past year, five new treatment options have been approved for locally advanced/metastatic bladder cancer, and studies continue in earlier disease states. The audience response session indicated that most meeting attendees were most familiar with Merck’s pebrolizumab (Keytruda), at 64 percent, vs. Genentech’s atezolizumab (Tecentriq) at 21 percent and BMS’s nivolumab (Opdivo) at 9 percent. As expected in a room full of practice leaders and progressive MDs, 87 percent of the audience responded that they want their practice to be prioritized for bladder and RCC initiatives in 2018, while 12 percent plan to wait until 2019. UroGPO has also compiled your feedback on preferred educational methods, with many requesting 2018 Bladder & RCC champs programs, UroGPO guidelines and in-office or virtual product-specific education. We are committed to working with you to develop the resources needed to bring these therapies to your patients. Please reach out to Ross Downing, rdowning@urogpo.us.com, for more information on UroGPO’s Bladder and RCC initiatives.

Potential new therapies for M0 CRPC

The non-metastatic castrate-resistant prostate cancer (M0 CRPC) space is proving to be an exciting area of research, with several therapies potentially becoming available in the near term. Drugs in development are Janssen’s apalutamide, Astellas/Pfizer’s enzalutamide and Bayer’s darolutamide. Currently, no therapy is approved for men in this stage of disease. The agents in development are oral therapies and will bolster practices that have an active in-office dispensary. UroGPO will be working with its medical consultants to build guidelines that address this new disease space. As many field leaders have noted, M0 disease is part of urology’s continuum of advanced prostate cancer care. New therapies in this arena will complement the existing operationalization of regular PSA monitoring, imaging frequency and treatment consistency.

Tackling Peyronie’s disease

UroGPO opened the 2017 meeting with its Men’s Health Initiative session, focusing education on the unmet need in Peyronie’s disease. As shown by the ARS responses, most men wait between seven and 12 months after noticing symptoms before receiving a diagnosis. This session’s education, along with UroGPO’s new exclusive contract offering for XIAFLEX® (collagenase clostridium histolyticum), may help with practice obstacles to care. The audience noted that less than 10 percent of men indicated for treatment with Xiaflex were receiving treatment, most likely related to a lack of experience (29 percent) or reimbursement (31 percent).  UroGPO will be working with the network to develop processes to identify and treat men with this condition.

UroGPO previews new BPH guidelines

Dr. David Sussman of Delaware Valley Urology delivered an overview of patient and treatment considerations for Benign Prostatic Hypertrophy (BPH) and rolled out a preview of the newly minted UroGPO BPH guidelines. Six months in the making and led by a dedicated group of advisors, the UroGPO guidelines approach BPH in simple, decision-tree format, with the goal of assisting the standardization of patient care. Print versions of the UroGPO BPH guidelines have been shipped to each of the member practices and digital versions are available through the UroGPO member portal or by clicking here.