Vos pairs ont répondu:
Abiraterone
Cabazitaxel
Olaparib
Radium-223
your answer
177Lu-PSMA617
Case 2022: Konstantinos (expert opinion by A. Bahl)
Konstantinos, 70 years old, plays the bouzouki. He spends hours and hours composing Laïkó music on his instrument. When he performs his new songs in a nearby bar, he is often praised as a local god. He was diagnosed with high-risk PCa 9 years ago.
Disease course:
- 9 years ago: prostatectomy
- 7 years ago: salvage radiotherapy for biochemical recurrence
- 6 years ago: started ADT for second biochemical recurrence
- 4 years ago: diagnosed with mCRPC with multiple bone metastases on bone scan; he started enzalutamide
- 9 months ago: radiographical progression with increase in bone metastases and new mediastinal and retroperitoneal lymphadenopathy. He started docetaxel. Docetaxel was stopped after 6 cycles due to grade 3 peripheral neuropathy.
Follow-up today (3 months after stopping docetaxel):
- Medical history: hypertension, medically controlled
- No known family history of cancer
- No germline and/or somatic BRCA1/2 mutation identified
- ECOG PS: 1
- Persistent peripheral neuropathy
- Fairly well-controlled pain (VAS score 3)
- Rising PSA: 110 ng/ml
- PSMA-PET/CT: progression in bone and mediastinal and retroperitoneal lymph nodes (all lesions with clear PSMA expression)
Expert opinion by A. Bahl
Abiraterone
Cabazitaxel
Olaparib
Radium-223
177Lu-PSMA617
1-3=inapproprié, 4-6=incertain, 7-9=approprié
Point de vue clinique : approbation réglementaire et restrictions locales non prises en compte
Preuves
What would Prof Amit Bahl do?
This 70-year-old musician would have been eligible to enter the VISION trial [1]. In this phase III study, radioligand therapy with 177Lu-PSMA-617 prolonged overall survival when added to standard care in patients with advanced PSMA-positive metastatic castration-resistant prostate cancer.
Abiraterone is an uncertain option. The CARD trial included patients progressing within 1 year of androgen receptor-targeted agent (ARTA) [2]. This patient had 3 years and 3 months on enzalutamide, so it is not clear whether sequencing with ARTA would be beneficial for this patient or not.
Cabazitaxel could have been an option, however, persistent peripheral neuropathy is an important consideration in deciding on systemic therapy. It is feasible that his quality of life, including his ability to perform musical instruments, could be affected by cabazitaxel.
This educational activity is supported by Advanced Accelerator Applications, a Novartis Company
Références
- Sartor O, de Bono J, Chi KN, et al. Lutetium-177-PSMA-617 for metastatic castration-resistant prostate cancer. N Engl J Med 2021;385:1091-103. PubMed
- de Wit R, de Bono J, Sternberg CN, et al. Cabazitaxel versus Abiraterone or Enzalutamide in Metastatic Prostate Cancer N Engl J Med 2019;381:2506-18. PubMed