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Provenge

"The U.S. Food and Drug Administration today expanded the approved use of Zytiga (abiraterone acetate) to treat men with late-stage (metastatic) castration-resistant prostate cancer prior to receiving chemotherapy.

The FDA initially appr"...

Provenge

SIDE EFFECTS

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The safety evaluation of PROVENGE is based on 601 prostate cancer patients in the PROVENGE group who underwent at least 1 leukapheresis procedure in four randomized, controlled clinical trials. The control was non-activated autologous peripheral blood mononuclear cells.

Almost all (98.3%) patients in the PROVENGE group and 96.0% in the control group reported an adverse event. The most common adverse events, reported in patients in the PROVENGE group at a rate ≥ 15%, were chills, fatigue, fever, back pain, nausea, joint ache, and headache. In 67.4% of patients in the PROVENGE group, these adverse events were mild or moderate in severity. Severe (Grade 3) and life-threatening (Grade 4) adverse events were reported in 23.6% and 4.0% of patients in the PROVENGE group compared with 25.1% and 3.3% of patients in the control group. Fatal (Grade 5) adverse events were reported in 3.3% of patients in the PROVENGE group compared with 3.6% of patients in the control group. The most common ( ≥ 2%) Grade 3-5 adverse events reported in the PROVENGE group were back pain and chills.

Serious adverse events were reported in 24.0% of patients in the PROVENGE group and 25.1% of patients in the control group. Serious adverse events in the PROVENGE group included acute infusion reactions [see WARNINGS AND PRECAUTIONS], cerebrovascular events, and single case reports of eosinophilia, rhabdomyolysis, myasthenia gravis, myositis, and tumor flare.

PROVENGE was discontinued in 1.5% of patients in Study 1 due to adverse events. Some patients who required central venous catheters for treatment with PROVENGE developed infections, including sepsis. A small number of these patients discontinued treatment as a result. Monitoring for infectious sequelae in patients with central venous catheters is recommended.

Each dose of PROVENGE requires a standard leukapheresis procedure approximately 3 days prior to the infusion. Adverse events that were reported ≤ 1 day following a leukapheresis procedure in ≥ 5% of patients in controlled clinical trials included citrate toxicity (14.2%), oral paresthesia (12.6%), paresthesia (11.4%), and fatigue (8.3%).

Table 1 provides the frequency and severity of adverse events reported in ≥ 5% of patients in the PROVENGE group of randomized, controlled trials of men with prostate cancer. The population included 485 patients with metastatic castrate resistant prostate cancer and 116 patients with non-metastatic androgen dependent prostate cancer who were scheduled to receive 3 infusions of PROVENGE at approximately 2-week intervals. The population was age 40 to 91 years (median 70 years), and 90.6% of patients were Caucasian.

Table 1: Incidence of Adverse Events Occurring in ≥ 5% of Patients Randomized to PROVENCE

All Grades n (%) PROVENCE
(N = 601)
Control*
(N = 303)
All Grades
n (%)
Grade 3-5
n (%)
All Grades
n (%)
Grade 3-5
n (%)
Any Adverse Event 591 (98.3) 186 (30.9) 291 (96.0) 97 (32.0)
Chills 319 (53.1) 13 (2.2) 33 (10.9) 0 (0.0)
Fatigue 247 (41.1) 6(1.0) 105 (34.7) 4(1.3)
Fever 188 (31.3) 6(1.0) 29 (9.6) 3 (1.0)
Back pain 178 (29.6) 18(3.0) 87 (28.7) 9 (3.0)
Nausea 129 (21.5) 3 (0.5) 45 (14.9) 0 (0.0)
Joint ache 118 (19.6) 11(1.8) 62 (20.5) 5(1.7)
Headache 109 (18.1) 4(0.7) 20 (6.6) 0 (0.0)
Citrate toxicity 89 (14.8) 0 (0.0) 43 (14.2) 0 (0.0)
Paresthesia 85 (14.1) 1 (0.2) 43 (14.2) 0 (0.0)
Vomiting 80 (13.3) 2 (0.3) 23 (7.6) 0 (0.0)
Anemia 75 (12.5) 11(1.8) 34(11.2) 7 (2.3)
Constipation 74 (12.3) 1 (0.2) 40 (13.2) 3 (1.0)
Pain 74 (12.3) 7(1.2) 20 (6.6) 3 (1.0)
Paresthesia oral 74 (12.3) 0 (0.0) 43 (14.2) 0 (0.0)
Pain in extremity 73 (12.1) 5 (0.8) 40 (13.2) 1 (0.3)
Dizziness 71 (11.8) 2 (0.3) 34(11.2) 0 (0.0)
Muscle ache 71 (11.8) 3 (0.5) 17 (5.6) 0 (0.0)
Asthenia 65 (10.8) 6(1.0) 20 (6.6) 2 (0.7)
Diarrhea 60 (10.0) 1 (0.2) 34(11.2) 3 (1.0)
Influenza-like illness 58 (9.7) 0 (0.0) 11(3.6) 0 (0.0)
Musculoskeletal pain 54 (9.0) 3 (0.5) 31 (10.2) 3 (1.0)
Dyspnea 52 (8.7) 11(1.8) 14 (4.6) 3(1.0)
Edema peripheral 50 (8.3) 1 (0.2) 31 (10.2) 1 (0.3)
Hot flush 49 (8.2) 2 (0.3) 29 (9.6) 1 (0.3)
Hematuria 46 (7.7) 6(1.0) 18(5.9) 3 (1.0)
Muscle spasms 46 (7.7) 2 (0.3) 17 (5.6) 0 (0.0)
Hypertension 45 (7.5) 3 (0.5) 14 (4.6) 0 (0.0)
Anorexia 39 (6.5) 1 (0.2) 33 (10.9) 3 (1.0)
Bone pain 38 (6.3) 4 (0.7) 22 (7.3) 3 (1.0)
Upper respiratory tract infection 38 (6.3) 0 (0.0) 18 (5.9) 0 (0.0)
Insomnia 37 (6.2) 0 (0.0) 22 (7.3) 1 (0.3)
Musculoskeletal chest pain 36 (6.0) 2 (0.3) 23 (7.6) 2 (0.7)
Cough 35 (5.8) 0 (0.0) 17 (5.6) 0 (0.0)
Neck pain 34 (5.7) 3 (0.5) 14 (4.6) 2 (0.7)
Weight decreased 34 (5.7) 2 (0.3) 24 (7.9) 1 (0.3)
Urinary tract infection 33 (5.5) 1 (0.2) 18 (5.9) 2 (0.7)
Rash 31 (5.2) 0 (0.0) 10 (3.3) 0 (0.0)
Sweating 30 (5.0) 1 (0.2) 3 (1.0) 0 (0.0)
Tremor 30 (5.0) 0 (0.0) 9 (3.0) 0 (0.0)
* Control was non-activated autologous peripheral blood mononuclear cells.

Cerebrovascular Events

In controlled clinical trials, cerebrovascular events, including hemorrhagic and ischemic strokes, were observed in 3.5% of patients in the PROVENGE group compared with 2.6% of patients in the control group.

Read the Provenge (sipuleucel-t suspension for intravenous infusion) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

No studies of drug interactions have been performed with PROVENGE.

Read the Provenge Drug Interactions Center for a complete guide to possible interactions

Last reviewed on RxList: 7/18/2011
This monograph has been modified to include the generic and brand name in many instances.

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