Treatment outcome of everolimus against neuroendocrine prostate cancer (NEPC).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 365-365 ◽  
Author(s):  
Tatsuya Shimomura ◽  
Takashi Kurauchi ◽  
Keigo Sakanaka ◽  
Shin Egawa
Keyword(s):  
Prostate Cancer ◽  
Tumor Markers ◽  
Neuroendocrine Tumors ◽  
Advanced Disease ◽  
Treatment Options ◽  
Neuron Specific Enolase ◽  
Radiologic Examination ◽  
Neuroendocrine Prostate Cancer ◽  
Improvement In Survival

365 Background: Neuroendocrine prostate cancer (NEPC) is a lethal disease subset with median overall survival of less than 1 year from time of detection. The treatment strategy against NEPC is not yet established. Some clinical trials are ongoing now. Recently, clinical trial (RADIIANT4) showed that treatment with everolimus was associated with significant improvement in survival in patients with progressive lung or gastrointestinal neuroendocrine tumors. And FDA approved new indication for everolimus for progressive, nonfunctional GI and lung neuroendocrine tumors last year. In this study we tried to introduce everolimus against pathologically proven NEPC and investigated the clinical outcomes of this agent. Methods: Total of seven cases were included in this study. All cases were proven the existence of neuroendocrine prostate cancer pathologically. Everolimus (10mg/d) were introduced into all cases. We investigated the neuroendocrine tumor markers (neuron-specific enolase: NSE, and pro-gastrin-releasing peptide: pro GRP), radiologic examination and survival. Results: The median follow up period was 6 months. At least one of the tumor markers increased above normal limit in all cases. NSE increased in four cases, pro GRP increased in five cases and both markers increased in two cases. Tumor markers decreased in five of seven (71.4%) cases (NSE: 2 of 4 cases, pro GRP: 4 of 5 cases) after introduction of everolimus. Median decreasing rate were 67.1% in NSE and 65.5% in pro GRP. Two of seven (28.6%) cases progressed in radiologic examination and died from prostate cancer. One case was very advanced disease and everolimus was introduced after failure of systemic chemotherapy (CDDP + etoposide). Another case was advanced disease with bone marrow carcinomatosis. In terms of adverse event, 4 cases had stomatitis and one case had hyperglycemia. Conclusions: In this study, evelolimus showed efficacy against NEPC. It decreased tumor markers and stabilized the tumor status. Although this study was retrospective and number of cases was limited, there is a possibility that evelolimus would be a one of the treatment options against NEPC.

The impact of Charlson Comorbidity Index on survival outcomes in men with prostate cancer who underwent definitive prostate radiotherapy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 114-114
Author(s):  
Ahmed I. Ghanem ◽  
Remonda M Khalil ◽  
Gehan Abd Elatti Khedr ◽  
Amy Tang ◽  
Amr A. Elsaid ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Charlson Comorbidity Index ◽  
Treatment Options ◽  
Patient Counselling ◽  
Prostate Radiotherapy ◽  
Survival Endpoints ◽  
Comorbidity Index ◽  
The Impact

114 Background: Life expectancy is very essential in deciding treatment options in men with prostate cancer (PCa); however, the impact of comorbidities on outcomes is not well-established. We investigated the influence of Charlson Comorbidity Index (CCI) on survival endpoints in men with localized PCa who were treated with prostate radiotherapy (RT). Methods: Men with intermediate and high risk PCa who were treated with definitive RT between 1/2007 and 12/2012 were included. Groups were created according to their baseline CCI score at diagnosis into no, mild and severe comorbidity (CCI 0, 1 or 2+). The groups were then compared based on patients’ characteristics and prognostic factors. Kaplan-Meier curves and Uni/multivariate analyses (MVA) were used to examine the impact of CCI groups on overall (OS), disease specific (DSS), and biochemical relapse free (BRFS) survival. Results: 257 patients were identified after excluding low risk, metastatic cases and those with inadequate follow up. Median follow-up was 92 months (range: 2-135) and median age was 73 years (range: 48-85). 53% of the cases were black and 67% were of intermediate risk. Median RT dose was 76 Gy and 47% received androgen deprivation therapy. CCI groups 0, 1 and 2+ encompassed 76 (30%), 54 (21%) and 127 (49%) patients, respectively. Groups were generally well-balanced. 10 and 15 years OS was significantly different across CCI groups (76% & 53%, 46% & 31% and 55% & 14%, for CCI-0, 1 and 2+ respectively; p < 0.001). CCI-0 had better DSS than CCI-2+ ( p = 0.03) with no difference for CCI-0 vs 1 ( p = 0.1). BRFS was non-different among CCI groups ( p = 0.99). On MVA, increased CCI was deterministic for OS ( p < 0.001) after adjusting for age, Gleason’s score and T-stage. For DSS, only age and T3 vs T1/2 were independently prognostic ( p < 0.001); whereas CCI-1 vs 0 was only marginal ( p = 0.05). Conclusions: Higher CCI was a significant predictor of shorter OS in intermediate and high-risk PCa. Baseline comorbidities should be taken into consideration during patient counselling for treatment options and in designing prospective trials for men with localized prostate cancer.

Combined brachytherapy and external beam radiation for prostate cancer in a community setting

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16147-e16147
Author(s):  
G. J. Kubicek ◽  
G. J. Kubicek ◽  
S. Brown ◽  
S. Redfield
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Treatment Options ◽  
Community Setting ◽  
Late Toxicity ◽  
Biochemical Failure ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

e16147 Background: Prostate cancer is the most common male malignancy, and there is no one standard treatment modality. One treatment option is the combination of external beam radiotherapy and permanent transperineal brachytherapy seed implant Methods: Retrospective review of prostate cancer and side effect outcomes at a single institution in the community setting. All patients were treated with a combination of low dose rate transperineal brachytherapy seed placement and external beam radiation. Results: A total of 897 patients were analyzed, 781 had a minimum follow-up of one year. Median pre-treatment PSA was 8.1 (range 0.3 to 106) and the median Gleason score was 6. With a median follow-up of 3.6 years, 33 (3.4 %) patients had biochemical failure based on the phoenix definition of Nadir + 2. Not including impotence, acute toxicity greater than or equal to Grade 2 was seen in 115 patients (102 GU and 13 GI) and 193 patients had late toxicity greater than or equal to Grade 2 (155 GU and 38 GI). 563 patients received hormone therapy prior to or concurrent with the radiation. Conclusions: This is the largest series reporting on the outcome of combination brachytherpay implant and external beam radiation in the treatment of prostate cancer. Combination treatment using brachytherapy and external beam radiation is well tolerated, with a low rate of biochemical failure and should be considered one of the treatment options for prostate cancer. No significant financial relationships to disclose.

Treatment outcomes of radiotherapy versus prostatectomy for localized prostate cancer with Gleason 8 or more on biopsy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 120-120
Author(s):  
Christopher Baker ◽  
Andrew M. McDonald ◽  
Grant Clark ◽  
Caleb Dulaney ◽  
Eddy Shih-Hsin Yang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Initial Treatment ◽  
Treatment Options ◽  
Current Treatment ◽  
Biochemical Failure ◽  
Localized Prostate Cancer ◽  
Kaplan Meier ◽  
Initial Biopsy

120 Background: There have been no prospective randomized controlled trials comparing current treatment options for patients with high-risk localized prostate cancer. This study seeks to compare the biochemical and metastatic outcomes of patients that received definitive radiotherapy (dRT) or radical prostatectomy (RP) for localized prostate cancer with Gleason score ≥ 8 on initial biopsy. Methods: A total of 106 patients met the inclusion criteria of Gleason score ≥ 8 on initial biopsy and biochemical follow-up ≥ 1 year. Seventy-one patients were initially treated with dRT (96% also receiving androgen deprivation therapy) and 35 patients were initially treated with RP (with or without postoperative RT). Our primary endpoint was biochemical failure (BF). For dRT patients, BF was recorded according to the Phoenix Consensus or if extranodal metastasis was diagnosed. For surgical patients, BF was recorded according to American Urological Association guidelines or if extranodal metastasis occurred. If adjuvant/salvage RT was given postoperatively, BF was recorded if PSA ≥ 0.5 on two consecutive measures after completion of RT. Pretreatment characteristics were compared using Pearson Chi-square method and independent samples Mann-Whitney U test. Actuarial rates of BF and metastasis were calculated using the Kaplan-Meier method. Results: Median follow-up for all patients was 5.3 years. There was no statistical difference in clinical T-stage, initial PSA, or months of follow up between patients treated initially with radiotherapy vs. prostatectomy. Patients initially treated with dRT were significantly older than those treated with RP. The dRT group had a lower rate of BF compared to the RP group, p < 0.001. The Kaplan-Meier estimate of BF at 5 years was 7.6% in the dRT group compared to 34.5% in the RP group. Additionally, the Kaplan-Meier estimate of distant metastasis at 10 years was 22.7% in the dRT group compared to 55.9% of the RP group, p = 0.01. Conclusions: For our sample of patients with Gleason score ≥ 8 on initial biopsy, initial treatment with dRT was associated with lower rates of biochemical failure and extranodal metastasis when compared to initial treatment with prostatectomy.

scholarly journals Neuroendocrine Tumors — Laboratory Diagnosis

2010 ◽  
Vol 29 (4) ◽  
pp. 254-264 ◽  
Author(s):  
Anna Tzontcheva
Keyword(s):  
Gastrointestinal Tract ◽  
Tumor Markers ◽  
Neuroendocrine Tumors ◽  
Chromogranin A ◽  
Endocrine Cells ◽  
Neuron Specific Enolase ◽  
Laboratory Diagnosis ◽  
Pancreatic Tumors ◽  
Endocrine Pancreatic Tumors ◽  
Well Differentiated

Neuroendocrine Tumors — Laboratory DiagnosisNeuroendocrine tumors (NETs) are a heterogeneous group of neoplasms originating from endocrine cells, which are characterized by the presence of secretory granules as well as the ability to produce biogenic amines and polypeptide hormones. These tumors originate from endocrine glands such as the adrenal medulla, the pituitary, and the parathyroids, as well as endocrine islets within the thyroid or the pancreas, and dispersed endocrine cells in the respiratory and gastrointestinal tract. The clinical behavior of NETs is extremely variable; they may be functioning or not functioning, ranging from very slow-growing tumors (well-differentiated NETs), which are the majority, to highly aggressive and very malignant tumors (poorly differentiated NETs). Classically, NETs of the gastrointestinal tract are classified into 2 main groups: (1) carcinoids and (2) endocrine pancreatic tumors (EPTs). Most neuroendocrine tumors produce and secrete a multitude of peptide hormones and amines. Some of these substances cause a specific clinical syndrome: carcinoid, Zollinger-Ellison, hyperglycemic, glucagonoma and WDHA syndrome. Specific markers for these syndromes are basal and/or stimulated levels of urinary 5-HIAA, serum or plasma gastrin, insulin, glucagon and vasoactive intestinal polypeptide, respectively. Some carcinoid tumors and about one third of endocrine pancreatic tumors do not present any clinical symptoms and are called ‘nonfunctioning’ tumors. Therefore, general tumor markers such as chromogranin A, pancreatic polypeptide, serum neuron-specific enolase and subunits of glycoprotein hormones have been used for screening purposes in patients without distinct clinical hormone-related symptoms. Among these general tumor markers chromogranin A, although its precise function is not yet established, has been shown to be a very sensitive and specific serum marker for various types of neuroendocrine tumors. This is because it may also be elevated in many cases of less well-differentiated tumors of neuroendocrine origin that do not secrete known hormones. At the moment, chromogranin A is considered the best general neuroendocrine serum or plasma marker available both for diagnosis and therapeutic evaluation, and is increased in 50-100% of patients with various neuroendocrine tumors. Chromogranin A serum or plasma levels reflect tumor load, and it may be an independent marker of prognosis in patients with midgut carcinoids.

Is neuron-specific enolase a useful tumor marker in the diagnosis and follow-up of patients with abdominal neuroendocrine tumors?

1995 ◽  
Vol 2 (4) ◽  
pp. 311-319
Author(s):  
U Meyer-Pannwitt ◽  
K Kummerfeldt ◽  
G Froeschle ◽  
V A Dorss ◽  
R Klapdor
Keyword(s):  
Tumor Marker ◽  
Neuroendocrine Tumors ◽  
Neuron Specific Enolase

Salvage radiation therapy after radical prostatectomy with the use of new technologies in radiation oncology

2016 ◽  
Vol 21 (1-2) ◽  
pp. 26-31
Author(s):  
S. I Tkachev ◽  
V. B Matveev ◽  
Petr V. Bulychkin
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
New Technologies ◽  
Treatment Options ◽  
Clinical Recurrence ◽  
Salvage Radiation Therapy ◽  
Prostate Bed ◽  
Grade 3

Introduction: prostate cancer (PCa) is the second cancer after lung one among all males. The main treatmentfor patients with localized prostate cancer is a radical prostatectomy (RP). After RP PCa occurs in patients at the T1-T2 stage - in 25 - 35% of all cases and in patients at the T3 stage - in 33.5 - 66% of all cases. Currently, one of the treatment options for patients with recurrence PCa after RP is a «salvage» radiation therapy. Materials and methods: medical records of 59 patients with PCa recurrence after radical prostatectomy (pT1-3pN0M0) were analyzed. Biochemical recurrence was observed in 25 (42,4%) and clinical recurrence in 34 (57,6%) patients. Radiotherapy have been prescribed to the regional lymphatic nodes to 44,0 Gy of 2,0 Gy each, to the prostate bed to 66,0 Gy of 2,0 Gy each and if the region of the clinical recurrence was identified - to 72 Gy of 2,0 Gy. Treatment was realized on linear electron accelerators using 3D technology radiotherapy: 3DCRT, IMRT, VMAT. Results: all 59 patients were treated by the «salvage» radiotherapy. Median follow-up was 48 months (24-91). Biochemical control w as achieved in 51 (86.4%) patients, locoregional control in 58 (98.3%) patients. No acute and late grade 3 or greater toxicities were observed.

scholarly journals Clinical Development of Cabazitaxel for the Treatment of Castration-Resistant Prostate Cancer

2011 ◽  
Vol 5 ◽  
pp. CMO.S6566 ◽  
Author(s):  
Che-Kai Tsao ◽  
Sonia Seng ◽  
William K. Oh ◽  
Matthew D. Galsky
Keyword(s):  
Prostate Cancer ◽  
Efflux Pump ◽  
Treatment Options ◽  
Clinical Development ◽  
Castration Resistant Prostate Cancer ◽  
Resistant Disease ◽  
Castration Resistant ◽  
P Glycoprotein ◽  
Drug Efflux Pump ◽  
Improvement In Survival

Castration resistant prostate cancer has historically been considered chemotherapy insensitive. However, the approval of estramustine phosphate, mitoxantrone, and docetaxel, over the past few decades, has challenged this notion. Despite these advances, until recently, only docetaxel had been shown to improve survival in patients with castration-resistant disease, and there has been no standard treatment options available for men with disease progression on docetaxel. In the last year, cabazitaxel, a novel taxane with decreased affinity for ATP-dependent drug efflux pump P-glycoprotein, became the first cytotoxic agent to demonstrate an improvement in survival in men with docetaxel-refractory disease, and has received regulatory approval for treatment in this setting. In this review, we examine the clinical development of cabazitaxel for the treatment of castration-resistant prostate cancer, as well as rationale and direction of future therapeutic investigation.

Circulating tumor cell (CTC) enumeration in patients with metastatic neuroendocrine prostate cancer (NEPC) and castration-resistant prostate cancer (CRPC).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 204-204 ◽  
Author(s):  
Gurveen Kaur ◽  
Beerinder Singh ◽  
Himisha Beltran ◽  
Naveed Hassan Akhtar ◽  
David M. Nanus ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Tumor Cell ◽  
Specific Antigen ◽  
Neuron Specific Enolase ◽  
Circulating Tumor Cell ◽  
Entire Group ◽  
Castration Resistant Prostate Cancer ◽  
Similar Frequency ◽  
Castration Resistant ◽  
Neuroendocrine Prostate Cancer

204 Background: Neuroendocrine prostate cancer (NEPC) is an aggressive variant of prostate cancer. Circulating tumor cell (CTC) counts as measured by CellSearch are prognostic for large groups with metastatic prostate cancer (PC), but are not well described in NEPC. Methods: With institutional review board approval, we retrospectively identified patients with metastatic PC and available CTC enumeration (CellSearch methodology) and compared counts/7.5 mL blood and overall survival (OS), measured from the first recorded CTC count until death or last follow up. Entry criteria for clinical trials were used to define NEPC, including histology (small cell/neuroendocrine carcinoma or adenocarcinoma with more than 50% NE staining), serum chromogranin greater than 5x ULN and/or neuron specific enolase greater than 2x ULN, and/or predominant liver/brain metastases with lack of prostate-specific antigen [Beltran ASCO 2013, clinicaltrials.gov NCT01799278 ]. Frequency of detectable and unfavorable counts was tabulated and OS was compared across groups. Results: Sixty one patients were identified: 21 NEPC with median age 73.7 and 40 patients with castration-resistant prostate cancer (CRPC) with median age 73.9 over contemporary time periods 2009 to 2012. Median OS for the entire group was 22.6 months (mo), with a trend for shorter OS in NEPC (20.7 mo) than CRPC (22.7 mo), p=0.11. 47.6% of NEPC and 55% of CRPC had detectable CTC counts (p=0.58); 38.1% of NEPC and 40.0% of CRPC had greater than or equal to five CTCs (p=0.89). CTC counts of 0 to 4 versus greater than or equal to five were prognostic for both groups: NEPC with 0 to 4 CTCs had median OS of 22.6 versus 6.6 mo for CTCs greater than or equal to 5 (p<0.001) and CRPC with 0 to 4 CTCs median OS not reached (mean 40.6 mo) versus 11.2 mo for those with greater than or equal to five CTCs (p<0.001). Conclusions: Patients with NEPC have similar frequency of detectable and elevated CTC counts by CellSearch methodology as compared to an overall CRPC population. CTC counts are prognostic for both groups.

scholarly journals Novel biomarkers for the detection of prostate cancer

2016 ◽  
Vol 9 (2_suppl) ◽  
pp. 3-10 ◽  
Author(s):  
Niels Asger Jakobsen ◽  
Freddie Charles Hamdy ◽  
Richard John Bryant
Keyword(s):  
Prostate Cancer ◽  
Disease Burden ◽  
Treatment Options ◽  
Specific Antigen ◽  
Response To Therapy ◽  
Response To Treatment ◽  
The Novel ◽  
Novel Biomarkers ◽  
Clinically Significant

Prostate-specific antigen (PSA) is widely used as a biomarker in the detection of prostate cancer and for decision making regarding treatment options, response to therapy, and clinical follow-up. Despite its widespread use, it is well recognised that PSA has suboptimal performance as a screening tool due to poor specificity, resulting in high negative biopsy rates and potential ‘over-diagnosis’ and ‘over-treatment’ of clinically insignificant cancers. In particular, PSA does not reliably distinguish either cancer from benign prostatic conditions, or ‘clinically significant’ from ‘indolent cancers’, and it is inaccurate in predicting disease burden and response to treatment. There is an urgent demand for novel biomarkers to address these clinical needs. This article provides an update on the novel candidate biomarkers in development, which have shown potential for improving the detection of clinically significant cases of this malignancy.

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