Glenn Tisman, MD Heme/Onc Blog

I frequently see patients with prostate cancer that want to know how long they will respond if they choose to be treated with intermittent androgen deprivation therapy (IADT). This involves the injection of a drug such as Lupron or Zoladex (LHRH agonist) usually on a 1-3 month basis plus or minus the ingestion of pills such as Celebrex, Flutamide, Nilutamide (anti-androgens) and Proscar or Avodart (inhibitors of activation of testosterone). A study by A. De La Taille et al. from France attempts to answer the question. From 1989 through 2001 these researchers studied 146 patients who had never receive hormone therapy before. They were treated in an intermittent fashion with LHRH agonist (Lupron, Zoladex) + non-steroidal anti-androgen (Flutamide, Casodex) = 28, LHRH alone = 42, non steroidal anti-androgen alone (i.e. Casodex, Flutamide) = 86. Disease Extent: Localized + locally advanced + metastatic prostate cancer = 72. Prostate-specific antigen (PSA) recurrence after radical pro...

Just a brief note about a patient with hormone resistant prostate cancer who was started on Revlimid (lenalidomide) 10 mg daily. He developed a severe rash and fluid retention and the dose was stopped to be restarted after symptoms abated. The drug was decreased to 10 mg every other day. The rash subsided and the PSA decreased for a period of many months. This patient represents one of three Revlimid treated patients who has had a PSA reponse to the drug (the other two have failed). I suspect that similar to Thalidomide, Revlimid is active in this disease. If a patient can get the drug ($250.00 per daily 10 mg capsule) it may be worth a try. Though Celgene (CELG) stock is down in recent trading I suspect that it will recover and go up in the future. The drug is also active in chronic lymphocytic leukemia (new finding), multiple myeloma and of course some myelodysplastic syndromes (5q deletion and others) to name a few indications.