How effective is enzalutamide in the real world?

Explore Xintiandi---MDT Selection Explore Xintiandi is sponsored by the Beijing Medical Award Foundation, guided by the Chinese Anti-Cancer Association Urology and Andrology Reproductive Tumor Committee, and fully supported by Yimaitong
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It aims to promote the communication and interaction of doctors in the field of urinary oncology-MDT resource sharing, academic cutting-edge broadcasts, and improvement of clinical diagnosis and treatment
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Click to watch the highlights of MDT highlights.
This issue of the MDT team from Shandong University Qilu Hospital and Weihai Municipal Hospital will bring you wonderful discussions
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Special report (1): Professor Zhu Yaofeng from Qilu Hospital of Shandong University in the field of mCRPC reported on the real-world data of enzalutamide in metastatic castration-resistant prostate cancer (mCRPC) before chemotherapy at the ASCO GU conference in 2020, and PSA The impact of the level on the prognosis of prostate cancer patients
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Professor Zhu said that real-world data show that enzalutamide can reduce the risk of death by 16% compared with abiraterone (18 months vs.
19 months); at the same time, enzalutamide has a median overall survival time compared with abiraterone.
(OS) is longer, 29.
6 months and 25.
87 months, respectively, which proves that the efficacy of enzalutamide in the real world is slightly better than that of abiraterone
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Special report (2): MR diagnosis of prostate cancer and PI-RADS scoring Professor Qiao Huijie from Weihai Municipal Hospital mainly reported on four aspects: PI-RADS introduction, anatomy and division, scanning technology and scoring and related issues
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Professor Qiao said that the total score of PI-RADS score is 5 points.
Scores 1 and 2 indicate that the possibility of prostate cancer is low.
A score of 3 requires clinicians to comprehensively consider the next treatment plan.
Scores 4 and 5 indicate the occurrence of prostate cancer.
The possibility is very high and a biopsy may be considered
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Case sharing and discussion (1) Professor Chen Shouzhen from Qilu Hospital of Shandong University shared with us the treatment process of "a case of prostate cancer with a Gleason score of 9".
Multidisciplinary experts made recommendations on the follow-up treatment plan for this case, and common clinical observations The issue was discussed
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The patient was male, 66 years old
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Main complaint: Swollen subclavian lymph nodes, shoulder joint discomfort
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Auxiliary examination: PET-CT suggests the possibility of prostate lesions, a needle biopsy is recommended
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◆Pathological puncture suggests prostate cancer, Gleason score 5+4=9 points diagnosis: prostate cancer (T3a? N1M1b)
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Treatment experience: 1.
Androgen deprivation treatment (ADT) + bicalutamide treatment was performed in March 2018
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2.
In March 2019, the PSA rose to above 2ng/ml again, and abiraterone was used for treatment, but the effect was not good, and local radiotherapy was performed
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3.
In November 2019, PSA rose sharply, and the multi-therapy regimen was changed: ADT + left suprarenal region radiotherapy + paclitaxel liposome + carrelizumab + bevacizumab
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How should treatment options be selected for prostate cancer patients who have already metastasized at the time of similar discovery? Experts express their opinions
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Professor Zhou Zunlin said that chemotherapy can be considered first to control the patient's PSA, so as to better control the condition
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In addition, each patient is an individual case, and the same universal diagnosis and treatment plan cannot be used.
For different patients, as long as the treatment plan is conceivable and affordable by the patient, you can try it, and it will indeed make the patient receive this kind of treatment.
Benefit later
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Case sharing and discussion (2) Professor Liu Lei from Weihai Municipal Hospital shared with us the treatment process of "Prostate cancer with a Gleason score of 7".
Experts from the two hospitals discussed and suggested the combined treatment plan for this case, and the clinical common The issue was discussed
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The patient was male, 64 years old
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Main complaint: elevated PSA
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◆Physical examination: Prostate cancer is Ⅲ degree high, hard in quality, and no other special abnormalities.
◆Magnetic resonance suggests prostate occupying, and the initial diagnosis is prostate cancer diagnosis: prostate cancer (Gleason score 3+4=7 points)
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Treatment experience: 1.
2016 Combined androgen blockade (CAB) treatment + external beam radiation therapy
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2.
Since April 2018, PSA has gradually increased.
In 2019, local external radiotherapy + docetaxel combined with prednisone treatment was performed, and the treatment effect was not good
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3.
In April 2021, PSA rose again, and abiraterone plus goserelin was used for treatment
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For this case, the various treatment options in the early stage did not reduce the patient's PSA well.
How should a new treatment method be selected in the follow-up? Professor Ma Shengjun said that such cases should not choose to undergo intermittent endocrine therapy at the beginning
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There are already CSCO guidelines for the treatment of high-risk and high tumor burden prostate tumors, and abiraterone should be used in the early treatment
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However, the PSA of abiraterone in this case continued to rise after a month, and it should be observed for another three or four months.
If the effect is not good after three or four months, Professor Ma believes that genetic testing should be done to determine the treatment plan
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In the special report, how should MR diagnosis and PI-RADS score be used for prostate cancer? In the case discussion, how should the follow-up treatment options be selected for patients whose PSA cannot be reduced by various treatment options? Click "Read the original text" below to watch the wonderful special report and MDT discussion
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Click "Read the original text" below to watch the full wonderful special report and MDT discussion