Another avenue of research in HRPC is immunotherapy, which is dependent on a suitable target antigen being presented to the immune system by an antigen-presenting cell (APC), such as the dendritic cell. The dendritic cell was chosen specifically because it is the most potent in eliciting a T-cell immune response. This approach has been evaluated in a randomized, placebo-controlled, phase III trial in HRPC patients with the drug APC8015. This is a product consisting of autologous dendritic cells loaded ex vivo with a recombinant fusion protein of prosta-tic acid phosphatase linked to granulocyte-macrophage colony-stimulating factor. This treatment was well tolerated and antigen-specific immunity was evident, but only in the subset of patients with a low Gleason score was there a trend toward improvement in median time to progression. A confirmatory phase III trial in these patients is now underway [53].

Vaccine-based therapies are also being evaluated. In one randomized phase II study, for example, recombinant pox viruses expressing PSA and the b7.1 co-stimulatory molecule were given to patients with nonmetastatic HRPC. Both immuno-logic activity and a delay in the development of metastatic disease at 6 months was seen [54]. Overall, targeting the immune system provides an exciting and novel approach to treating prostate cancer.

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