Evan Y. Yu, MD

Case Review: 66-Year-Old Develops mCRPC

Initial Impressions of Patient With High-Risk Localized PC

Overall Survival Data in mCRPC

Pragmatic Considerations for Early Radium-223 in mCRPC

Significant Impact of COVID-19 on the Treatment of mCRPC

Setting Realistic Goals With Palliative Therapy in mCRPC

Rapidly Expanding Options in mCRPC

Case: A 66-Year-Old Man with Metastatic Castration-Resistant Prostate Cancer

A 66-year-old man presented with increasing difficulty walking and sleeping on his back due to lower back and hip discomfort

PMH: hypertension, medically controlled; no known family history of cancer

PE: DRE revealed a nodular prostate; otherwise unremarkable



Biopsy with TRUS showed adenocarcinoma of prostate

Chest/abdominal/pelvic CT scan showed no evidence distant metastases or lymph node involvement

EBRT for 8 weeks + neoadjuvant concurrent, and adjuvant ADT for 2 years

At 6 months post-ADT follow-up; PSA 5.9 ng/mL

Patient reported continued back discomfort, difficulty walking and loss of appetite

Bone scan showed multiple lesions in the right femur and pelvis

Abiraterone + ADT was initiated for 1 year

Patient complained of increased bone pain in right femur

Treatment with radium-223 dichloride was initiated; 6 infusions completed and well-tolerated at post-infusion follow-up

Videos

Evan Y. Yu, MD, discusses the case and subsequent palliative treatment plan for a patient with metastatic castration-resistant prostate cancer.

Case Review: Rationale and Methods in mCRPC

Evan Y. Yu, MD, professor, Department of Medical Oncology, University of Washington School of Medicine, member, Clinical Research Division, Fred Hutchinson Cancer Research Center, and clinical trials core director, Genitourinary Medical Oncology, Seattle Cancer Care Alliance, discussed the key takeaways from the phase Ib/II KEYNOTE-365 trial, which evaluated different novel pembrolizumab (Keytruda) combinations in patients with metastatic castration-resistant prostate cancer (mCRPC).

Forty-one patients were treated in cohort A with pembrolizumab plus olaparib (Lynparza); this combination induced modest response rates in the molecularly unselected patients with mCRPC. This represents a heavily pretreated patient population, where about 25% of patients had previously received all available treatment strategies, including abiraterone acetate (Zytiga), enzalutamide (Xtandi), docetaxel, and cabazitaxel (Jevtana), according to Yang.

The overall response rate (ORR) was 7% at a median follow-up of 11.4 months, and while this ORR is small, it is significant for this patient population, says Yang. In patients with soft tissue disease, 14% had a significant PSA decline (&ge;50%), compared to 12% in the overall population.

Yang says it is hard to confirmprogression in nontarget lesions such as bone metastases, or in bone scans that may look worse. In all but 1 of the patients who responded, they had progressed in nontarget lesions and bone lesions. Yang says it&rsquo;s common to see responses with immunotherapy, but it&rsquo;s rare to see a short-term response followed by progression elsewhere.

Evan Y. Yu, MD, discussed the key takeaways from the phase Ib/II KEYNOTE-365 trial, which evaluated different novel pembrolizumab (Keytruda) combinations in patients with metastatic castration-resistant prostate cancer.

Key Takeaways from KEYNOTE-365 in Metastatic Castration-Resistant Prostate Cancer

Evan Y. Yu, MD, associate professor, Department of Medicine, Division of Oncology, Seattle Cancer Care Alliance, discusses the utility of PET imaging for the treatment of patients with prostate cancer.

Recently, the US Centers for Medicare and Medicaid Services (CMS) decided to pay for fluorodeoxyglucose positron emission tomography (FDG-PET)

FDG-PET maybe useful for both detection as well as imaging treatment response in metastatic castration-resistant disease

The Utility of PET Imaging in Prostate Cancer

Evan Y. Yu, MD, associate professor, Department of Medicine, Division of Oncology, Seattle Cancer Care Alliance, discusses the role of PET imaging in prostate cancer.

Various types of PET imaging can be used to help detect prostate cancer and measure prostate cancer treatment responses

A study that explored sodium fluoride PET as a marker in treatment response with dasatinib showed a longer progression-free survival

PET imaging showed that ARN-509 was hitting its intended target and helped researchers determine the optimal biologic dosing for the agent

Using PET imaging in clinical trials will help researchers get a better understanding the mechanism of action of some novel agents

Evan Y. Yu, MD, discusses the role of PET imaging in prostate cancer.

Evan Y. Yu, MD | Authors

Articles

Case Review: Rationale and Methods in mCRPC

Key Takeaways from KEYNOTE-365 in Metastatic Castration-Resistant Prostate Cancer

The Utility of PET Imaging in Prostate Cancer

Novel PET Imaging in Prostate Cancer