ONCAlert | 2018 ASCO Annual Meeting
Prostate Cancer Case Studies

William Oh, MD: Comparison of Chemotherapy to a Secondary Hormone at the Time of Progression

William Oh, MD
Published Online:Jul 21, 2016
Mathew J is a 61 year old African American male who presented to his primary care physician with lower urinary tract symptoms, including sporadic hematuria. He complains of abdominal pain and low back pain starting four months ago and increasing in frequency.

Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 2

Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 1
Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 2


At the time of progression, would you go back to chemotherapy or use a secondary hormone?

We know that these patients will eventually progress. If we assume that this patient may progress about two years after he completes treatment, that would not be an unusual timeline. And the question is, what should we do at that time? Should we start back on chemotherapy? Should we consider an AR-targeted therapy or something else? And this is a question that we really don’t fully know the right answer to, partly because the CHAARTED and STAMPEDE patients have not been followed long enough to know whether there’s an optimal sequence of next treatment.

I normally start metastatic CRPC patients who progress first-line with an androgen receptor (AR)–targeted therapy. In this type of patient I might use abiraterone/prednisone, or enzalutamide. Some of these patients I’ll also, if they’re relatively asymptomatic, use a treatment like sipuleucel-T.

It is not inappropriate to consider chemotherapy. One of the questions that some people ask is, if the patient just received docetaxel 24 months ago and has now progressed, should you go back to docetaxel? I think the answer is that it’s an appropriate consideration. Some people are wondering whether or not going to an alternative chemotherapy like cabazitaxel may be appropriate in a patient like this since it had been relatively recent that he received docetaxel. I don’t think we know the answer to that. But an AR-targeted therapy in this setting, if he progresses after 24 months, would be completely appropriate.

CASE: Metastatic Prostate Cancer (Part 2)

Mathew J is a 61 year old African American male who presented to his primary care physician with lower urinary tract symptoms, including sporadic hematuria. He complains of abdominal pain and low back pain starting four months ago and increasing in frequency. Prior medical history includes non-insulin dependent diabetes mellitus, well-controlled on metformin since 2006. The patient was referred to urology for further evaluation. ng/ml.

During his most recent follow-up exam, the patient complained of intermittent back pain and increasing fatigue.  

  • Digital rectum exam revealed nodular prostate /L
  • Serum PSA level; 129 ng/ml
  • Alkaline phosphatase, 258
  • TRUS/prostate biopsy: 53 gram prostate, 12/12 cores (+), Gleason 4 + 5
  • CT indicates blastic lesions to lumbar spine and pelvis
  • Bone Scan positive for T/L spine, pelvis, right femur, scapula
  • ECOG performance status, 1

 

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