So, how does Keytruda work in prostate cancer patients?
Well, there's a technical answer and then there's probably a more common sense answer
and that is that it just enhances the immune system globally to be more reactive and active
against cancer, and our immune system is always working on our behalf to fight the cancer
and so the Keytruda strengthens that fight and improves the efficacy of the immune system.
I mean, you mentioned the side effects, but in combination with everything else, the side
effects of Keytruda, over time, you've just seen that it's pretty short-lived and once
you're on the drug those are the side effects? Or does it have any permanent side effects?
It can have permanent side effects and one of the things about the immune system, one
of the good things, is that when you implement immune therapy, the impact on the immune system
or the immune system has a memory, and so, it will keep going after the treatment is
stopped and that's true for side effects too—that if men develop side effects from immune therapy
that it can be ongoing after the treatment is stopped.
And is there any way to mitigate those or is it just kind of something that they need
to watch for?
Well, it's, I'll tell you, Keytruda is complex because there are so many. You can get thyroid
problems, adrenal problems, and so people need to be monitored closely, and the first
step, of course, is to cut back on the dose or stop the medicine. The second step is to
use some cortisone to try and calm the immune system down and it's pretty custom in how
people react to these medicines.
I know a question that we get in our comments is people are wondering how effective Provenge
versus Keytruda versus Olaparib, so can you explain? I know there's differences of when
it'll work in a certain type of, you know, with certain sets of genetics.
Well, I think, you know, both Provenge and Olaparib are FDA-approved to treat prostate
cancer, so if you look at the efficacy of Olaparib versus Provenge, they're probably
similar. Both of them work better when you get after the treatment at an earlier stage
rather than waiting until the cancer becomes very advanced. The efficacy of Keytruda has
not been proven yet. There's a phase III trial ongoing and how much of an impact that will
have on survival is, as of yet, unknown.
In your practice, obviously, you've treated men with Keytruda, so have you seen some really
amazing miracle cases or has it just been in combination with all the other treatments?
Well, it's effective. We published a clinical trial showing that about half of the men with
prostate cancer that underwent treatment with Keytruda, sometimes in combination with other
things, would develop PSA stabilization or a PSA decline with the therapy. So, it's a
useful drug. It was clearly shown in the studies that we did that men that who had lower PSAs
and lower volume cancers did better than the ones that had really advanced cancers.
So, is Keytruda and injection, a pill?
Keytruda in an injection, an infusion, given every three weeks. So we mentioned Provenge,
it is also an infusion, it is given every two weeks for a total of only three doses.
And then, the Xtandi, as we all know, is a pill.
So, how does a man have access to Keytruda since it's not FDA-approved currently?
Well, Merck Pharmaceuticals has been very generous; they have a very easily accessible
compassionate use protocol. So, the medical oncologist merely has to request it and provide
some background information and the medicine is provided free-of-charge from Merck.
So, can any medical oncologist get access to Keytruda through Merck?
As far as I know. The access has been quite easy and there've been very few stipulations
and we have had patients in other states seen by other oncologists who've requested the
same program and accessed the medicine with little difficulty.
You mentioned that patients can get access to Keytruda through compassionate care use,
so does that mean that company is giving the drug to the patient? Do they have any costs
involved with that?
The drug is free. So, the drug is provided to the oncologist who then is able to pass
it on free-of-charge to the patients.
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