Chemotherapy for oligometastatic prostate cancer.

[pjoshea13]

New paper below.

My first reaction was Why? With oligo-mets (i.e. only a few), the idea is to treat as one would the primary cancer; by surgery &/or radiation. Why use a systemic approach for very limited mets?

& then there is the STAMPEDE trial that found benefit primarily in high volume cases - which oligometastatic disease clearly isn't. The paper does mention this. However:

"Oligometastatic patients may not all share the same biology. Advanced imaging techniques may help to more accurately identify truly oligometastatic patients. Molecular markers will be necessary to distinguish oligometastatic patients who fare well enough with androgen deprivation therapy alone as opposed to those for whom upfront chemotherapy may be beneficial. Emerging molecular markers of docetaxel sensitivity, such as loss of lysine-specific demethylase 5d, warrant prospective validation with one goal of identifying oligometastatic patients with greatest likelihood of benefit from this strategy."

I had a solitary met at L5 zapped in 2015. I can't imagine my doctor suggesting Taxotere, even if he was an oligo-doubter, which many are.

-Patrick

ncbi.nlm.nih.gov/pubmed/288...

Curr Opin Urol. 2017 Aug 16. doi: 10.1097/MOU.0000000000000446. [Epub ahead of print]

Chemotherapy for oligometastatic prostate cancer.

Dorff TB1, Sweeney CJ.

Author information

Abstract

PURPOSE OF REVIEW:

To analyze recent trials of upfront chemotherapy to determine how this paradigm can be applied to oligometastatic prostate cancer patients.

RECENT FINDINGS:

Upfront chemotherapy prolongs survival in metastatic prostate cancer, according to the ChemoHormonal Therapy versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer and STAMPEDE docetaxel trials. However, the benefit is driven by the high volume subset and may not apply to low-volume/oligometastatic patients.

SUMMARY:

Oligometastatic patients may not all share the same biology. Advanced imaging techniques may help to more accurately identify truly oligometastatic patients. Molecular markers will be necessary to distinguish oligometastatic patients who fare well enough with androgen deprivation therapy alone as opposed to those for whom upfront chemotherapy may be beneficial. Emerging molecular markers of docetaxel sensitivity, such as loss of lysine-specific demethylase 5d, warrant prospective validation with one goal of identifying oligometastatic patients with greatest likelihood of benefit from this strategy.

PMID: 28817399 DOI: 10.1097/MOU.0000000000000446

[BigRich]

Patrick,

With 3 lymph nodes that have been reduced by a third with just 150 mg. casodex monotherapy. I think i should give Lupron and Zytiga an opportunity to eliminate them from being seen on a CAT scan; give it a year, but monitor scan every 6 months.

Rich

[Sisira]

How do you say "with very limited mets"? May be now, what has been identified by scanning. But in advanced PCa there should be many mets all over the body at micro level even the latest PET/CT scans such as Gallium 68 PSMA or Choline C11 PET/CT Scan will not be able to identify. Such hidden cancer cells also will be all types, marking their time to proliferate. IMO Oligometastatic PCa is a myth! This may be to generate more business to Myo Clinic to use their Choline C11 PET Scan ( Only they have this facility ) and then do the expensive Surgery/Radiation treatments for those few Mets identified. Will advanced PCa stop with only a few mets? Very doubtful! On the other hand should we wait until the cancer volume will begin to grow exponentially to apply a systemic treatment. Obviously, it would be much better and easier to destroy a smaller volume of microscopic cancer cells as well along with the identified few mets using early Chemo which is a systemic and also a cytotoxic protocol, notwithstanding its known side effects.

Sisira

[Break60 in reply to Sisira]

I'm not sure there is such a thing as oligomets either but so far that's what I've had: Two iliac lymph nodes and one femur met found two years apart. I had ALL pelvic lymph nodes treated with combo of ADT and RT and the one femur met treated with xgeva, ADT and SBRT. Carpet bombing and nuke.

Bob

[Hidden]

One word. Micro metastasis. Once mutated cells are in the lymphatic vascular systems, the only treatment today is wholesale destruction visavie chemotherapy while the body is strong and the tumor burden minimal. Anything else is a delay. Whether to delay or kill is a decision which you make.

Gourd Dancer

[Sisira in reply to Hidden]

Thanks gourd dancer. That is exactly what I wanted to emphasize.

Sisira

[gusgold]

sounds like BIRM and modified citrus pectin should help