Provenge

Provenge Expansion

Advanced Prostate Cancer, David Emerson, Dendreon, Provenge -
Last year at this time I had the opportunity, along with 40 other prostate cancer advocates, to tour the Dendreon manufacturing facility in New Jersey. At the time the company was weeks away from FDA approval of Provenge and construction of the expanded facilities were in full swing. As I wrote at the time, it was very, very impressive.

Just last week they were finally granted FDA approval to begin using the expanded capacity, increasing from twelve to forty-eight stations.

This is great news for many, many men throughout this country battling against the advanced stages of prostate cancer.

There are two other sites currently under construction, in Georgia and Southern California.  Dendreon is pursuing approval for these two sites and hoping to bring them on line later this year.

A good day and great news for the PCa community!

….And finally…..Happy St. Patrick’s Day!!!!!!!! 

My Abby Road

Abiraterone, Advanced Prostate Cancer, David Emerson, Kreskin, Provenge -

I was looking for this post a few weeks ago, when it became apparent that Abby (Abiraterone) would become my next treatemnet.

I’m not suggesting that I’m Kreskin or Nostradamus, but it is crazy how close I was with some of the things in this post from two and half years ago. Provenge, I was nearly right on the money, it was 19 months later.

October 17, 2008

The fruits of medical research are growing. Here we are in February 2011 and there are a number of promising treatments on the horizon. Most are still in trial stage, but things are a lot different than the picture this old post paints. More options means hope and that is a good thing.

On another note, the dead of winter has set in with a vengeance and I really look forward to Spring.

New Year, new direction

Abiraterone, Advanced Prostate Cancer, David Emerson, Provenge, PSA -

Tomorrow is my 28 day appointment with my Oncologist. Due to the holidays, time flew by and I really find it hard to believe it is time to return to the cancer center.

I’m not sure what to expect with my PSA score. Regardless of what the results will be, we have to make a decision this week regarding the next treatment. We are still pursuing Provenge in New Jersey as well as Abiraterone in Los Angeles. Even though it will require a fair amount of travel, we are leaning towards Abiraterone. The reason we are favoring Abiraterone is that we believe I will have a much better chance of reducing my PSA and that is what we need to focus on at this point. This is not to rule out Provenge or to even say we don’t do both. I’m not sure that doing both simultaneously is even possible, but you never know.

The holidays were great. We saw a lot of family and enjoyed each other’s company. I think subconsciously we may be trying to store up the energy required for what lies ahead. This is a very brief update, more details over the next few days.

Go west, young man

Abiraterone, Advanced Prostate Cancer, CT scan, David Emerson, Provenge -

Dr V called Friday night with the results of my CT scan. That’s right, my doctor calls patients at home on a Friday night! His news was for the most part good.
1) No, the cancer has not spread to any organs.
2) The radiologist noted a new tumor in the T5/6 vertebrae. This was new compared to the CT scan from 12 months ago, but we were made aware of this new tumor when he communicated to me the results of my last bone scan, which was last month.
3) There are three areas with enlarged lymph nodes, two nodes above my prostate, two below and two in my neck. The largest being approximately 3cm or a little more than an inch, this was near my prostate. The other areas were smaller.  He recommended for now we keep an eye on these and they should go down as we treat the disease in total. In other words, get my PSA down and these could go away as well.

This news is good in the sense it just eliminated one option and made my next treatment decision a choice of two Provenge (immunotherapy – vaccine) or Abiraterone (oral – pill). Both are going to require travel, the former to the east coast, the other to the west. I’ll wait and see how things evolve but there’s a little voice saying, ‘Go west, young man’.

An alteration, a variation or perhaps I just go with ‘an adjustment’?

Abiraterone, Advanced Prostate Cancer, David Emerson, PCa, Provenge, XL 184 -
I had my monthly appointment with my oncologist, Lupron shot and Zometa infusion yesterday. The latter two items went off without a hitch, as usual.
My PSA however was up again and now at 81.2

I was not at all surprised with this increase based on the previous two PSA readings and how I feel.  Let me clarify how I feel, overall I feel great. However, because I have a very high tolerance for pain and the fact that after six years of this I am very in tune with every ache and pain in my body, I knew the PSA was up. Nothing severe, just an occasional twinge in my hip or leg(s) etc., no Advil needed it comes and goes.

So it seems that the DES (estrogen) has run its course and so it’s time for a change. We have discussed a number of possible treatments with Dr. V however, two are not yet available and the doctor’s team is still trying to coordinate the third. Given this and the need for a change we decided that as a short term stop-gap I would replace the DES with high-dose Casodex. Casodex is an anti-androgen that is combined with Lupron as the ‘standard’ treatment when men are initially diagnosed with advanced PCa. I was initially on Casodex for the first year after diagnosis. In a high-dose dosage there were a few small studies ten years ago that showed some limited benefit. If my results are nothing more than the stabilization of my PSA while we line up the next treatment, I’ll take it.

On another note, the doctor did feel a slightly enlarged lymph node in my neck. He didn’t seem too worried but I am having an abdominal CT scan on Thursday just to be safe.  There are times I think my laissez-faire attitude or sarcasm leaves Dr. V dumbfounded. For example, after telling me about the lymph node and the order for a CT scan, I responded with the following; ‘Well I guess the CT could result in a bad news, good news situation. The bad news is we found something, the good news is you now qualify for the XL 184 trial!’  He had no idea how to respond.

Just so you the reader understands, I honestly believe that because life itself is far too serious, you have to see the irony in things, and retain a little bit of sarcasm in your everyday life. Mary and I laugh a lot at this whole situation. When we left the doctor she said (thick with sarcasm)  “Oh well, just another appointment, your numbers are up, you have a swollen lymph node in your neck, you  have to have a CT scan, your iron level is down and I have three new prescriptions to get filled!” We then went on to ponder whether or not there was something wrong with us because of the way we react to news like the news we just received?  Shouldn’t we be upset, emotional, pissed-off, something? We are not naïve nor are we emotionless, it’s just after this much time we don’t fly off the handle or get too worried. It is what it is and we have to let it all play out before our eyes.

Help me help the PCa community!

Advanced Prostate Cancer, David Emerson, MEDCAC, PCa, Provenge -
As I mentioned yesterday, one of the options that might be available to me is a new drug called Provenge. Though this treatment was approved by the FDA back in April, Medicare is still dragging their feet.  I do not have Medicare, but this decision has an indirect impact on my insurance coverage because most private insurers follow the lead or negotiate the amount they pay the pharmaceutical companies, based on the decision of Medicare.
The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) of the Centers for Medicare & Medicaid Services (CMS) meeting is Wednesday, Nov 17th. Discussion will focus on the currently available evidence regarding the clinical benefits and harms of on-label and off-label use of Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer (aka Provenge), and if it is adequate for the Committee to advise that the treatment costs be covered by Medicare.
THIS should be very important to all of you, regardless if you or a loved one has Prostate Cancer. Why? This is a landmark and historic decision by MEDCAC as they are evaluating for the first time ‘how much is too much’? Depending on their decision, it could have historic impacts on other cancer treatments, as well as other medical treatments in general.
We still need your help…

For those of you who have not already signed the petition, please do so by clicking the links below. If you have already signed it, I thank you for your action, but ask you to please forward this email to family, friends, and anyone who might be interested in signing it.

Help me help the PCa community and sign the online petition NOW

David

‘Ladies and gentleman, we’re going to be here awhile’

Abiraterone, David Emerson, PCa, Provenge, PSA, XL 184 -

The title is a frivolous attempt at humor, but it appears we are in another holding pattern.

With all of the information that continually bombards those of us dealing with PCa, it was good to hear the doctor from Boston say this today, “You have done a remarkable job of managing your case by not panicking and constantly switching protocols. You have managed to survive longer than the average, longer than most,and in very good overall health!”. This is not the first time we have heard this.  We also heard it when we visited MD Anderson in April 2009. It tends to make me puff out my chest when two of perhaps the top five Prostate Cancer researchers in the country reaffirm that we have made the right decisions throughout my treatment process. Long term, things are bad, but they could always be worse.

After reviewing my chart and discussing my case for 15-20 minutes, the doctor informed us that I am not currently a candidate for XL 184 (A requirement for the trial is that lymph node and/or organ involvement would need to be present in addition to the bone metastasis). Believe it or not, I was not discouraged, mostly because of the doctor’s words and presence. He was unbelievably gracious and supportive.  He encouraged us to stay in touch and invited us to confer with him again before we make any treatment changes in the future.  He also reminded us that clinical trials change and my condition might change as well.

I obviously am not a doctor, but my experience with this journey tells me this, because my treatment options are limited, I have to get the most out of each treatment. When making  the decision regarding when it is the best time to alter treatments, I believe it is a combination of considering quality medical advice, PSA doubling times, scan results the patient’s overall health and how he is feeling and then following your personal instincts.  That has been our approach, and so far, so good!

With XL 184, we were just trying to line up another option. XL 184 is targeted directly to the bone tumors, which peaked our interest in this relatively new treatment option. When the time comes to choose the next treatment regimen, we plan to have two or three options lined up, Provenge, Abiraterone, or maybe this newer drug XL 184.  It is truly a luxury for an advanced prostate cancer patient to have treatment options after being diagnosed almost 6 years ago.

The good news, and this is sometimes hard for me convey in words, is that unlike when I started this journey,there are more options. Five years ago my next step would have been to try chemotherapy again. Since it didn’t work as well as we had hoped the first time, the chances of it working a second time are not very good. Now, in late 2010, I find myself with three potential treatments.  It will be a difficult decision, but it won’t have to be made until sometime in the future.  Once again I find myself sleeping well and remaining encouraged that in the midst of my chaotic life, things are very encouraging!

It’s a good news, bad news thing…..

Advanced Prostate Cancer, David Emerson, hrpca, Provenge, PSA, radiation -
I’ve written here are a few times about a recently approved and very exciting new treatment for advanced prostate cancer, a drug known as Provenge. Well it seems the demand is far exceeding the company’s capacity to keep up. This is something I saw first hand back in March and something that the company has been very clear about since the FDA approval in late April.

From Bloomberg: Rationing of Provenge

It’s just kind of sad to see in writing and know that even after Dendreon expands their existing facility and opens two others by the middle of next year, it will take some time to clear the back log of patients.

By the way, the title had nothing to do with my personal situation. Yesterday I received my 14th and final radiation treatment. For the most part the whole process was easy. I had some increased pain the first week and was rather fatigued as well. I have however been completely off pain meds for a week now and the fatigue is in the past as well.

We met briefly with the radiation oncologist and I can begin to exercise again but to avoid any exercise involving my legs for the next few weeks. Walking will be fine, but I have to avoid sit-ups so there goes the six pack abs I was working on! Disc golf of course is still a non-issue for at least two months, that is a hard pill to swallow, but I am very thankful that the pain is gone.

This is big, this is REALLY big!

Advanced Prostate Cancer, David Emerson, hrpca, PCa, Provenge -

Today the Federal Drug Administration approved Provenge for use in certain men with advanced prostate cancer. Here is the press release: http://bit.ly/bgfhul

This is the first new treatment for advanced prostate cancer to be approved in something like 15 years.

With an estimated 192,280 new cases of prostate cancer each year, and with approximately 27,360 men expected to die from the disease in 2009, this is significant. Just to be clear, this is NOT a cure. Provenge is a new treatment that has shown a survival benefit of four months

over the current treatment, Taxotere. Additionally, it is given over three treatments spanning a month and the side effects are significantly less than those associated with chemo (Taxotere).

There are a lot more details to be released from Dendreon such as availability, cost and where it will be available. Dendreon has provided more information at: http://www.provenge.com

My ability to use it in the future is uncertain. I’m not sure I will qualify and I’m not sure how much and/or where I can even get it for some time. The important thing is that it is now another viable option in my very narrow inventory of future treatment options.

All in all, a good day, no a great day for the cause!

I am quite honored

Advanced Prostate Cancer, David Emerson, PCa, Provenge -
I received an email last month that I was literally on the verge of deleting, but I am quite relieved that I didn’t. I have been invited to attend a “Patient Advocate Summit” for Dendreon Corporation. If all the red tape with the FDA is cleared, this Spring they are launching a new treatment called “Provenge’. I have written about it here on numerous occasions, as far back as October 2006.

Provenge has always been on our ‘what’s next’ treatment list. A quick description is this: blood is extracted from the patient and sent to Dendreon where is it infused with an immunotherapy. It takes about three days to send back and forth. Once the patient’s blood is returned, the compound is reintroduced to the patient. Although there has been a lot of controversy with the FDA and the clinical trials over the years, the most recent data shows that Provenge may prolong life for six months on average. Our hope is that I would be on the high end of the survival range. Given my health is otherwise good and I am relatively young, our intention is that my immune system would kick in and really attack the prostate cancer cells.

The site we are visiting will be one of the first three at which Dendreon is expanding the processing, once they receive final FDA approval.

I feel rather honored to have been asked to participate and am looking forward to the meeting tomorrow. I will be learning more about the clinical trials and new potential treatments as well, and will of course share my knowledge with all of you!

I also am looking forward to meeting a number of the ‘virtual’ friends I have come to know over the past five years!