Emmanuel S. Antonarakis, MBBCh, professor of oncology, Johns Hopkins Medicine, discusses a phase II trial of sipuleucel-T (Provenge) plus radium-223 dichloride (Xofigo) versus sipuleucel-T alone in patients with asymptomatic bone-metastatic castration-resistant prostate cancer (mCRPC).

If this combination was ever approved for this patient subset, administering the therapy would require a significant amount of coordination and collaboration between nurses and doctors of different disciplines.

From a nursing perspective, this is important because these 2 therapies take a little bit of coordination. Sipuleucel-T is typically given by medical oncologists, but it requires a leukapheresis, which in many places is done by a Red Cross facility. The radium-223 is either given by nuclear medicine physicians or the radiation oncologist, depending on where you are. So this is truly an interdisciplinary type of trial to conduct. If this ever was to become standard, this would truly require a collaboration both between nursing staff in the medical oncology clinic and the nuclear medicine or radiation oncology clinic.

But also the physicians needs to be talking to each other as well. The [medical oncologist] will be administering the sipuleucel-T, the [radiation oncologist] or the [nuclear medicine physician] would be administering the radium-223, so this is truly an example in advanced disease where a multi-center, multidisciplinary collaboration would be required. Usually we think of multidisciplinary collaboration in treating early or primary disease, where you're thinking about should this patient get radiotherapy to the prostate, surgery? Combination therapy? But this would be an example in the castration-resistant setting where you would need a multidisciplinary approach and the nursing aspect and the collaboration and coordination there would be key.

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Investigative mCRPC Treatment Requires Team Approach

Emmanuel S. Antonarakis, MBBCh, an associate professor of oncology at Johns Hopkins Medicine, discussed updated National Comprehensive Cancer Network (NCCN) guidelines for the genetic testing of men with prostate cancer.

Germline testing, which looks for inherited gene mutations, and somatic testing, which examines the genetic makeup of the tumor itself, can be useful in making therapy decisions. According to the NCCN, every patient with metastatic or high-risk localized non-metastatic prostate cancer should undergo germline testing. Additionally, men with lymph node metastases or distant metastases should undergo genetic testing.

Emmanuel S. Antonarakis, MBBCh

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Investigative mCRPC Treatment Requires Team Approach

NCCN Guidelines for Genetic Testing in Prostate Cancer