Results from Foundation One Cdx, IHC, Neuroendocrine tests

[dvcarola2]

After my husband’s bone biopsy in January, here are the results:

Immunohistochemical stain:

panCK - positive

CK7 - negative

CK20 - negative

PSA - positive

NKX3.1 - positive

Neuroendocrine markers:

Synaptophysin - negative

Chromogranin A - negative

Other results:

PD-L1 - negative

And the foundation one cdx result (attached pic) just came back and it did not reveal any possible treatment options which is heartbreaking to say the least.

Can somebody please help me understand these results and what other options do we have. My husband tried and failed on Zytiga, chemo (docetaxel), Zytiga, Lu177 and now trying Xtandi before moving on to cabazitaxel and possibly with Xofigo but Im not sure if I can source this one out in Singapore because its not available here in the Philippines.

Is there a chance that Xtandi might work given that he has AR deletion exons 5-7?

Since synaptophysin and chromogranin A are negative, not NePca?

Also, he is losing weight fast and Im trying to give him protein shakes along with regular food. He still has his appetite but I noticed that there’s massive loss on muscle mass right after his bone biopsy procedure.

Appreciate all your inputs please. TIA.

[tallguy2]

The standard of care suggests cabazitaxel is next in line. There may also be clinical trials that are right for him. Concerning though is the weight loss. What have scans such as a CT or PET-Axumin shown regarding the extent of the mets?

Best wishes.

[dvcarola2 in reply to tallguy2]

Here in the Phils there are no clinical trials for pca or none that I know of. His latest F18 PSMA petscan end Dec 2020 showed increased in size and number of bone mets but soft tissue mets decreased in size after 3rd Lu177 infusion. His psa then was 2.something but just after a month, January this year, his psa doubled to 4 already. So, doctor wanted us to try Xtandi first because we havent tried that yet. If that fails, we move on with cabazitaxel and after that I dont know anymore 😢

[Tall_Allen]

Unfortunately, there's nothing actionable there. But that's also a good thing - there's no indication of NEPC or anything really virulent. I assume histology was normal too?

It is common for the AR to lose exons as it mutates. It is part of the process of castration resistance. He is still producing PSA, so the AR is still active. Can you ask them to stain for PSMA?

[dvcarola2 in reply to Tall_Allen]

Yes histology is normal. Im guessing he has high PSMA expression which is the reason why we went ahead with Lu177 treatment but had gotten mixed results. Anyway, I can have the PSMA stain done the next time we go for doctor’s checkup which will be in 2wks time to see if husband is responding to Xtandi.

Is there any other relevant treatment options if in case PSMA stain is positive?

[Tall_Allen in reply to dvcarola2]

Let's see what it shows.

[j-o-h-n]

TAE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 02/16/2021 8:20 PM EST

[dvcarola2 in reply to j-o-h-n]

Shit happens John

[j-o-h-n]

Tell me about it.......... I'm on a diet............ NO ice cream 😢😢😢

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 02/21/2021 11:26 PM EST