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The presence of a BRCA2 mutation tells us he would benefit from the PARPI, however indication is only in the mCRPC space. I would offer docetaxel for this patient based on the aggressive histology, high volume disease including viscera involvement and considering his good performance status.
Jose Luis Soto Rodriguez
docetaxel x6 cycles
Both Enzalutamide and Arbiraterone + Prednisolone are suitable alternatives. I would suggest keeping the Docetaxel for relapses
Docetaxel 6 cycles
Enzalutamide (Xtandi), but if not effective, olaparib (Lynparza) or rucaparib (Rubraca), and if still not effective, docetaxel plus carboplatin x6 cycles. If all not effective but patient still mobile, possibly pembrolizumab (Keytruda).
Docetaxel 6 cycles
The patient is young and with good performance status so should be offered upfront Docetaxel chemotherapy
emine sevil bavbek
Docetaxel 6 cycles. Tempted to add platinum with the BRCA mutation, but no data in the HAPC setting
Luis Felipe Lara Moscoloni
Two research comments:
Germline BRCA2 carriers who received first-line abiraterone or enzalutamide (Xtandi, Astellas) vs. taxanes had longer cause-specific survival (24 months vs. 17 months) and PFS2 (18.9 months vs. 8.6 months).
Patients with metastatic castration-resistant prostate cancer and harboring germline mutations in BRCA1/2 and ATM benefit from treatment with abiraterone and enzalutamide
In any event, a prognosis for a patient with the status identified is, unfortunately, not good despite the good intentions of suggested therapies.
farhood khaleghi mehr
apalutamide or enzalutamide. Chemo after progression (docetaxel plus platin based). Olaparib if progression after chemo
doxetacel x 6 cycles
docetaxel (alto rischio alto volume)
More clinical trial clearly needed in this space....one day we may add a PARP inhibitor. The ADT + "novel hormones" gives a better PFS than ADT + docetaxel.....buying more time until progression allows to be more creative in the future. This patient may respond well to DNA damaging agents like Lu-177 tagged to PSA targeting agents. Would be great to get the trial open with ADT + novel hormone +/- PSMA Lu-177
Dr. Sartor’s recommendation for Lutetium-177 PSMA is certainly one of the best approaches in this case once approved by the FDA. Currently, this treatment is only approved for use in Germany, with a few other countries prescribing as a novel treatment option. So far with Phase III of the VISION trial, the intermediate results demonstrate that Lutetium-177 PSMA therapy leads to a significant improvement in biochemical and radiological parameters, improves the quality and general life expectancy of patients with metastatic prostate cancer. According to statistics obtained during the relevant international VISION and LuPSMA trials, the use of Lutetium-177 leads to a significant improvement in the results of laboratory tests and PET-CT (more than 57% of patients), and also improves quality (more than 70% of patients) and expectancy of life (more than 45% of patients).
Pending Moderator approval.
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