“My main goal is to find some way of identifying more targetable markers that might give me more treatment options.” – Robert Ellis
“What other things should I be talking to my doctor about or see if I can get lined up for after the current treatment that I’m on, after I stop responding to my current treatment?” – Robert Ellis
Robert Ellis is an advanced prostate cancer patient who is looking for guidance on his treatment options and strategy after he stops responding to his current treatment. In particular, he is interested in tests that could uncover biomarkers that would lead to targetable treatment options he could discuss with his doctor.
What is Robert’s current situation?
Robert was diagnosed in October 2017 with advanced prostate cancer – it had metastasized to his bones. Over the last five or six years he has been through many rounds of treatment: several androgen deprivation therapy (ADT) drugs, focused radiation, immunotherapy, a PARP inhibitor, and chemotherapy. His disease, as measured by Prostate Specific Antigen (PSA) tests, which he has gotten as frequently as every three weeks, has risen and fallen three times.
He is currently on a hormone therapy (Orgovyx), a PARP inhibitor (Rubraca), a urination drug (dutasteride), and supplements, including metformin. His PSA is currently low (1.7).
He is considering two treatment options for his next line of treatment: (1) radiation particles targeted at Prostate Specific Membrane Antigen (PSMA), called “Pluvicto” or “Lutetium 177”, and (2) bipolar androgen therapy, where testosterone is introduced to the cancer cells which have been bred to survive in a hormone-deprived environment.
Robert’s priority for treatment is quality of life – enjoying his life, choosing approved drugs, not riskier treatments, low side effects, and not choosing treatments that would take a lot of time or travel to access. He is interested in drug combinations, intermittent treatments, and rechallenging.
What additional testing options were suggested?
- Liquid biopsy, e.g., the Tempus xF+ test, can provide biomarkers for targeted treatments.
- Proteomic analysis, e.g., mProbe tissue analysis, can provide new biomarkers for targeted treatments.
- Standard Uptake Values from a PSMA PET scan will indicate whether he is likely to have a response to PSMA-targeted radiation therapy.
- Current status of PDL1/PD1, tumor mutation burden, and MSS/MSI, can help predict whether he will likely be responsive to immunotherapy.
- Whole genome and RNA sequencing can identify biomarkers which may be targetable.
- Bone biopsy, possibly the bone aspirate liquid biopsy being researched by Peter Kuhn, to be able to analyze bone tumors.
What additional treatment options were suggested?
- An Androgen Receptor (AR) degrader (ARV-110 or ARV-766 clinical trial), given the high expression of AR as noted in the Caris report.
- CAR-T, if there are indications that an immunotherapy might work.
- Drug combinations of abiraterone + olaparib + sulindac, carboplatin + degarelix + sulindac, apalutamide + lutetium lu 177 vipivotide tetraxetan + sulindac, abiraterone + olaparib, carboplatin + degarelix, and apalutamide + lutetium lu 177 vipivotide tetraxetan
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