AR L702H question

[longleaf]

So Mike did the guardant analysis and it says he has 1.5%ctDNA or mod for the AR L702H gene mutation. I know this is associated with castration resistance but is there other relevant information about what this might mean? Are there trials for this? Does this mean some treatments might not work as well?

The psa is 11+ now. He will be getting a psma scan on Wednesday if the material comes in (we already had one cancellation).

[Javelin18]

I found a 2019 study where they looked at Androgen Receptor (AR) gene mutations to see if they were predictive of resistance to enzalutamide treatment.

ascopubs.org/doi/10.1200/PO...

The abstract says the study was inconclusive for AR mutations. My layman assessment is that with the low percentage of AR mutation in his sample is that the majority of the cancer wouldn't be resistant.

I would ask his doctor if that is a correct interpretation.

[Javelin18]

Here is an article that discusses androgen receptor mutation and potential therapies.

sciencedirect.com/science/a...

I'll try to wade through it and see if I can summarize it.

[Tall_Allen]

Castration resistance should be considered a process rather than an either/or state. There are probably some mutated cells even early on that later come to predominate. There are several clinical trials for medicines targeted at the androgen receptors, but all of those trials require clinical evidence of castration resistance (rising PSA that is above certain levels).

[longleaf]

The psa is definitely rising and dr said he is castration resistant. Monthly psa’s starting in Feb psa 3+, 8+,11+ We are looking to see if he will be good candidate for lutetium if he can get psma scan.