Immunotherapy (Dendritic Cell Therapy) where is it being used?

I believe Provenge in the US is exactly that: immunotherapy that uses dendritic cells collected from the patient to treat metastatic castration-resistant prostate cancer.

Are you referring to some sort of broader application in Germany? It would help if you were more specific in what you're asking, or provided a source.

Wideurt, the FCA approved the world's first commercial dendritic cell vaccine (Sipuleucel-T / Provenge) in 2010.

@gently And the EMA approved Provenge for the EU in 2013. Then, unfortunately, the company Dendreon filed for Chapter 11 bankruptcy in 2014, and as part of their reorganisation, decided not to pursue the European market.

Part of the problem was that Provenge extended survival (vs placebo) but not progression-free survival: it kept patients alive longer, but didn't do anything to slow down the cancer. Shortly after Provenge came out, the first -lutamide (Enzalutamide) also came out, which extended both survival *and* progression-free survival — reducing PSA and often shrinking tumours — and -lutamides are simple, shelf-stable pills that can be shipped around the world at room temperature, while Provenge requires extracting T-cells, shipping them to a central facility (which would have had to be built in the Europe), and getting them back to the patient, all within a 48-hour window.

I suspect Dendreon rightly judged that EU countries simply wouldn't be interested in a treatment that cost €75K+, required infrastructure comparable to organ transplants, and was less-effective than pills. There are also other escalations available if ARSIs like the lutamides stop controlling the cancer (e.g. Pluvicto).

(FWIW, Health Canada never approved Provenge either, though Canada does support immunotherapies like CAR-T for other cancers, because there's good evidence that they provide an additional benefit.)

@notpetecrowarmstrong From what I was told, Germany is quite well-known for immunotherapy for cancer patients. I live in Germany and am very closed to several prostate cancer centers that are under CCC(https://www.ccc-netzwerk.de/startseite.html). CCC are the comprehensive cancer centers. Those centers are highly specialized oncology treatment and research facilities that are usually affiliated with university hospitals. Then, there are some hospitals that are clinical partners with each CCC. They focus on multi-disciplinary patient care. Two particular centers within 1.5 hours driving from my house are well know for their advance immunotherapy program. Upon my last research, they are currently on Phase I trial of CC-1 Bispecific Antibody.

Currently, there is also a new type of PSMA scan that is available at University Saarland Hospital. It's called zirconium-89 (⁸⁹Zr) PSMA PET/CT scan. It uses zirconium tracer, instead of F-18 or Gallium-68. The scan is span in 72-hour period. I know several German patients who got this type of scan, but they said it is not covered by the statutory health insurance. Here is the link about it in German: https://www.uks.eu/fileadmin/uks/kliniken_und_einrichtungen/radiodiagnostik-nuklearmedizin-strahlentherapie/nuklearmedizin/Themenbilder/PET-CT-Zentrum/BPS-Magazin_2-2022_Rosar-Ezziddin_18.07.2022.pdf

@northoftheborder thanks.

@prettypass2000 Thanks for sharing that info, it's very helpful to learn about practices and developments in other countries.

I translated that paper about the Zr PSMA scan and here's the key observation for anyone who's interested: Because of the longer half-life [of the zirconium-89], images can be acquired several days post-injection (e.g., day 2 or 3). Over time, normal body tissue clears out the tracer while prostate cancer cells retain it continuously. This significantly improves image contrast and background noise ratio, enabling the detection of previously invisible, small, or low-PSMA-expression tumor lesions. This is particularly helpful for patients with low PSA levels who may be experiencing biochemical recurrence, since traditional radiotracers with their short half-lifes may be insufficiently cleared by normal tissue (e.g., the urinary tract) to allow visualization of very small lesions. That's a big part of why so many conventional PSMA PET scans are negative at low PSA levels: the "noise" from uptake by healthy tissue blocks out the visibility of small lesions in the area.

@notpetecrowarmstrong I was just looking at some trials on immunotherapy and this popped up and it read like no relapse and hardly no side effects (mild flu like symptoms) . Most invasive part was the biopsy. Yes it sounded pretty good.

@wideurt, I expanded the title of your discussion to reflect your question regarding dendritic cell therapy and where it is available.

@rleech asked a similar question here:
- Has anyone undergone Dendritic Cell Therapy?https://connect.mayoclinic.org/discussion/has-anyone-undergone-dendritic-cell-therapy/

Mayo Clinic has several articles about their work in immunotherapy. Here are a few specific to dendritic cell therapy:

- Rewiring the dendritic cell: Regulatory T cell axis sensitizes prostate cancer to immunotherapy https://www.abstractsonline.com/pp8/
Description: The study investigates whether increasing the number and functionality of dendritic cells simultaneously with Treg depletion is effective in overcoming the distinctly "cold" prostate tumor microenvironment. The findings have the potential to yield new immunotherapeutic approaches for prostate cancer treatment.

- New approaches to immunotherapy for glioblastoma https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/new-approaches-to-immunotherapy-for-glioblastoma/mac-20488153
- Harnessing the immune system to fight ovarian cancer https://newsnetwork.mayoclinic.org/discussion/harnessing-the-immune-system-to-fight-ovarian-cancer/

@notpetecrowarmstrong You're welcome. According to some patients who got this scan, it can reveal the lesions and tumor sites that are missed by standard short-lived PSMA tracers. However, from what I did some digging, it still cannot detect any cancer cells that are still very small(like ≤ 2mm with 3 mm is at the borderline). It costs around 2100-2500 euros according to some patients and brochures. I am not sure if it costs more for those who have private health insurance, like my husband. His F-18 PSMA scan here is about 3200 euros, but it can be cheaper or higher depending on the centers and the multipliers they use when they do billing. In Germany, the medical practices are legally allowed to use multipliers(up to 3.5) for each itemized medical code's fees for patients who have private health insurance. I have learned all of this when my husband was diagnosed in 2021. It's very mind blowing, but their fees are still much cheaper than in US (We are Americans).

@wideurt Here is the info I found on Dendritic cell therapy. So in Germany, Dendritic cell therapy is primarily administered through specialized private oncology clinics and certified immunotherapeutic laboratories. At large university hospitals, they don't offer this treatment but occasionally host specific, strictly regulated clinical trials testing next-generation dendritic cell formulations for specific tumor profiles. It costs €15,000 to €38,000 for a complete primary treatment program, depending on the centers, but it can also cost more than those estimated price. Here, you are allowed to ask for cost estimation. I do it on every treatment/procedure because I have to pay the medical bill to the practices and file for reimbursement from our health insurance company.