NEPC Treatment Question: Hello all... - Advanced Prostate...

Advanced Prostate Cancer

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NEPC Treatment Question

Hello all!

Mike was dx with NEPC this past summer. You can view his history in my profile. He recently completed 6 cycles of carboplatin+etoposide+tecentriq. Recent CT scans completed after his last cycle show the mets are stable with a small amount of improvement. While we are celebrating this news, his oncologist is looking ahead. Following along with treating this like a Small Cell Lung Cancer she is suggesting radiation next. She has mentioned radiation to the prostate and to the brain as a preventative. We had a baseline MRI of the brain complete at the start of his current treatment with no mets discovered. Immunotherapy is ongoing every 3 weeks. We met with a radiation oncologist back in September and the conversation was geared toward radiation for symptom management. I was under the impression that neuroendocrine tumors don’t respond to radiation, with some evidence indicating it may promote PCa transformation into NEPC. Here is some literature that I was able to find suggesting it is not effective for extensive stage disease. We are with the Cleveland Clinic Taussig Center. I would like to consult with Dr. Beltran with Dana Farber in Boston. She has studied NEPC extensively. I would love to hear your thoughts.

Nikki

ncbi.nlm.nih.gov/m/pubmed/2...

bmccancer.biomedcentral.com...

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Bird8

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11 Replies

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Tall_Allen5 years ago

I agree that it is unresponsive to radiation, but that is very different from the proposed PCI - the idea seems to be to change the microenvironment of the skull (not the brain) so the cancer can't flourish there. It appears to work.

I did not know what you meant by "some evidence indicating it may promote PCa transformation into NEPC." I have never heard of radiation doing this.

Dr Beltran is the expert.

Bird8• in reply toTall_Allen5 years ago

Hi TA. Thank you for the reply. So it seems more effective for the skull, not the brain? Interesting.

I was not aware about radiation possibly leading to ADT resistance and thus NED until I read this. Not sure how frequently it occurs.

ncbi.nlm.nih.gov/pmc/articl...

Tall_Allen• in reply toBird85 years ago

"Cranium" means the skull, not the brain.

Bird8• in reply toTall_Allen5 years ago

Thank you TA. I understand that. The oncologist told us brain. She may have meant skull. More info to come tomorrow after appt with radonc.

Bird85 years ago

Thank you for the reply Nalakrats. He is getting tecentriq.

tom67inMA5 years ago

Is ductal more likely to become NEPC? Because that would explain my history nicely.

Bird85 years ago

Yes, he was PD-L1 negative with genomic testing on tumor prior to NEPC differentiation. Waiting for results from genetic testing with new biopsy sample. I was apprehensive about immunotherapy working for him.

DenDoc5 years ago

Best guide should be the more recent genomics on the current biopsy which is assumed to be NEPC. Genetics may be completely different than it was on the original adenocarcinoma since that cancer has morphed into NEPC.

Targeted therapy should be more specific than just radiating an area that might be involved.

I am 18 months post treatment for NEPC with Carboplatin and Etoposide. Tumors are stable with no new growth and I do not have any chest fluid which was a problem before the chemo.

My next treatment will be Olaparib when they grow again.

Bird8• in reply toDenDoc5 years ago

Thank you for the reply DenDoc! You have been through a lot. Glad that you have a had a good response to treatment. Original genomic testing showed Mike carries the BRCA2 gene and olaparib was listed as a tx option. We had genetic testing on the new, differentiated, tumor. Waiting for those results. I know of another case of a pt being treated with Lynparza that had a wonderful response. Best of luck to you!