PCL #27 - "Treatment Options Review for Advanced Prostate Cancer Patient Mike Yancey"
Channel: Cancer Patient Lab
Date: 04/11/2023

Prostate Cancer Lab #-27 Sept 28, 2022
Discussion forum: https://community.cancerpatientlab.org/home

Full transcript: https://docs.google.com/document/d/1176hYKDTEx0wOzxVqaf81NBL6uT8x52ckm8lUnlulB0/edit?usp=sharing

“My cancer is very aggressive. I have PTEN loss and mutations in the RB1 and the TP53 genes. Those three together are known as tumor suppressor genes, and if you have any two out of three, that's considered an aggressive variant. And I got three out of three. Lucky me.” 

“RB1 is one thing to look at and study, but we have to include PTEN and TP53, and look at the signaling pathways, and what drugs are available that can begin to impact them. A lot of the drugs that we're going to look at today haven't been tested in prostate cancer; they've been tested in other cancers and shown some benefits for some of these pathways. And of course, when we start mixing multiple drugs, we get back into the bigger issue of no clinical trials and no dosing information.” — Mike Yancey

Meeting Summary
In this meeting, advanced prostate cancer patient Mike Yancey discussed (1) his medical history, (2) the treatment opportunities and challenges he is facing now, and (3) his testing and treatment strategy. Mike has an aggressive prostate cancer driven by some key mutations that he believes needs to be treated with an equally aggressive drug combination.

Medical History
Mike had been diligent in getting an annual physical and having his PSA tested. In July 2021 his PSA rose to 2.4, and he was diagnosed with metastatic prostate cancer. He had metastases in his bones, walking was difficult. 

In early 2022 Mike and a doctor he was seeing discussed a study he had seen that showed that another hormone therapy drug (abiraterone) was effective after the chemotherapy he had taken (docetaxel). The doctor suggested Mike take it since it would not hurt anything - he started in April 2022.

In May 2022, feeling a recurrence of bone pain, this time in his shoulders, he consulted with a new oncologist in Houston who determined that his cancer was a very aggressive type. Testing revealed mutations in three key “tumor suppressor genes” (PTEN loss, and RB1 and TP53 mutations). If someone has mutations in any 2 of these 3 genes, then the cancer is designated “Aggressive Variant Prostate Cancer”. 

Mike got a scan that looks for a protein (Prostate Specific Membrane Antigen - PSMA) found on the surface of prostate cancer cells. It lights up where it finds the protein, which confirmed his cancer had spread from his pelvis, spine, and right femur into his shoulders. He had an unusually high expression of PSMA (30 to 40 standardized uptake value vs. a median of 8.8, ranging from 2.1 to 62.4), which indicated he would be a good candidate for a newly approved therapy that combines a radioisotope that binds to PSMA to deliver radiation directly to the cancer (Pluvicto). 

Mike stepped through additional issues.

Mike has had a liquid biopsy.

The primary purpose of our conversation was to figure out what Mike should do after he completes his current line of therapy with Pluvicto.

Besides the recommendations from his medical team, Mike has received information on treatment options from Foundation Medicine, which did his gene sequencing. 

Testing and Treatment Strategy
Mike plans to have PSMA-PET scans done in the next few weeks, prior to his third round of treatment with Pluvicto, and then do them again prior to the fifth round of treatment, and a final set of scans after he has completed the Pluvicto treatment course (the 6th round of treatment). 

Mike’s treatment strategy depends on understanding the signaling pathways associated with his key mutations, and what drugs are available that can impact them. 

Mike’s research has convinced him that his unique aggressive combination of genomic mutations (PTEN loss, RB1, and TP53) calls for multiple therapies at the same time to attack multiple signaling pathways, rather than the traditional application of single agents, or serial application of single agents. Therefore, the drug combination treatment recommendations from CureMatch are at the top of his list. 

Treatment Options Walkthrough
Mike used a spreadsheet to organize his finding, recommendations, and thinking and stepped through it.

Mike has identified 17 treatment options, 8 of which he has ranked on his short list because they stood out as having a higher probability of success.

The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.