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Abstract
<p class="first" id="d5357575e133">Sipuleucel-T, an autologous cellular immunotherapy
manufactured from antigen-presenting
cells primed to recognize prostatic acid phosphatase, was the first immunotherapy
product approved by the US FDA. It was approved for men with asymptomatic or minimally
symptomatic metastatic castration-resistant prostate cancer after it was shown to
provide a survival advantage. Additional studies have examined its use in other clinical
settings and in combination with other approved and investigational immunotherapy
agents. This review will discuss the pivotal trials leading to approval, will outline
some of the biomarkers associated with its efficacy and will review some of the ongoing
combination strategies. Maximizing the efficacy of sipuleucel-T through better patient
selection or through combination approaches remains the challenge of the future.
</p>
Sipuleucel-T (APC8015) is an investigational immunotherapy product designed to stimulate T-cell immunity against prostatic acid phosphatase. A phase III study was undertaken to evaluate the safety and efficacy of sipuleucel-T in a placebo-controlled study. A total of 127 patients with asymptomatic metastatic hormone refractory prostate cancer (HRPC) were randomly assigned in a 2:1 ratio to receive three infusions of sipuleucel-T (n = 82) or placebo (n = 45) every 2 weeks. On disease progression, placebo patients could receive APC8015F, a product made with frozen leukapheresis cells. Of the 127 patients, 115 patients had progressive disease at the time of data analysis, and all patients were followed for survival for 36 months. The median for time to disease progression (TTP) for sipuleucel-T was 11.7 weeks compared with 10.0 weeks for placebo (P = .052, log-rank; hazard ratio [HR], 1.45; 95%CI, 0.99 to 2.11). Median survival was 25.9 months for sipuleucel-T and 21.4 months for placebo (P = .01, log-rank; HR, 1.70; 95%CI, 1.13 to 2.56). Treatment remained a strong independent predictor of overall survival after adjusting for prognostic factors using a Cox multivariable regression model (P = .002, Wald test; HR, 2.12; 95%CI, 1.31 to 3.44). The median ratio of T-cell stimulation at 8 weeks to pretreatment was eight-fold higher in sipuleucel-T-treated patients (16.9 v 1.99; P < .001). Sipuleucel-T therapy was well tolerated. While the improvement in the primary end point TTP did not achieve statistical significance, this study suggests that sipuleucel-T may provide a survival advantage to asymptomatic HRPC patients. Supportive studies are underway.
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