A 70-Year-Old Man with Metastatic Castration-Resistant Prostate Cancer - Episode 6

Future Directions and Unmet Needs

Dr. Morgans discusses unmet needs and importance of including multidisciplinary teams when treating patients with mCRPC.

Alicia Morgans, MD, MPH: Until we cure patients of prostate cancer, including metastatic CRPC [castration-resistant prostate cancer], there will always be an unmet need in this disease space and for these men. Combinations of therapies, including 177Lutetium or not, will hopefully get us over the goal line at some point and give us the opportunity to say—even for men with disease that we can’t cure—they’re cured. There are many exciting combination studies being done with radiopharmaceuticals, PARP inhibitors with AR [androgen receptor]–directed therapies, immunotherapies, and other things that we don’t know exist but are in early phase 1 or first-in-human trials and are moving into our field. It’s an incredibly exciting time in prostate cancer, and I look forward to seeing our opportunities for treatment grow; the sky is the limit. With a partnership between patients who want to engage in clinical trials and physicians who can open and run these safely and effectively for our patients, we can make quite a difference over time.

One piece of advice that I would offer is to continue to engage as multidisciplinary care teams that includes urologists and medical oncologists but now will increasingly also include nuclear medicine physicians and others who feel comfortable and are skilled to give our radiopharmaceuticals. We’re also recognizing that supportive care of bone health and protecting the cardiovascular health of our patients is critical. Engaging with our colleagues who can help support patients in these areas, and learning those skills on our own and incorporating them into our clinics, is critical in treating the whole patient.

Transcript edited for clarity.

A 70-Year-Old Man with Metastatic Castration-Resistant Prostate Cancer

May 2017

Initial presentation

A 70-year-old man presents with nocturia and decreased appetite

Clinical workup

  1. PMH: Unremarkable
  2. PE: DRE, enlarged prostate
  3. TRUS and biopsy revealed adenocarcinoma of the prostate gland, Gleason score 9 [5+4]
  4. CT showed minimal nodal involvement
  5. PSA 42 ng/mL, LDH 404 U/L
  6. His ECOG PS is 1

Treatment

  1. Patient started on ADT with initial PSA response 12 ng/mL

December 2017

  1. Patient complained of right hip pain and abdomen pain
  2. Imaging with CT and bone scan showed 2 metastatic bone lesions in the pelvis and diffuse liver lesions
  3. PSA 30 ng/mL; Hb 9.4 g/dL; ANC 1.5
  4. Patient started on docetaxel, 6 cycles completed
  5. Follow-up imaging showed stable disease

November 2018

  1. PSA 40 ng/mL
  2. Routine imaging shows new metastatic bone lesions in the pelvis
  3. Patient started on abiraterone and prednisone, after 6 months he has a restaging scan which shows continued progression of disease

January 2019

  1. Patient had a 68Ga-PSMA-11 scan when screening for the VISION trial which shows several positive metastatic lesions in the pelvis and liver metastases
  2. He qualified on screening and enrolled in a clinical trial and treated with 177Lu-PSMA-617 as per the VISION protocol (7.4 Gbq [100 mCi] every 6 weeks for 4-6 cycles)