VALORACIÓN DE RESPUESTA EN CPRC METASTÁSICO ÁLVARO PINTO Servicio de Oncología Médica Hospital Universitario La Paz – IdiPAZ, Madrid
THERAPEUTIC LANDSCAPE (2004) Tamaño y actividad del tumor (medido según nivel de PSA) Pre metastásico Metastásico Asintomático Sintomático Docetaxel Exitus Años 10 11,5 Terapia deprivación andrógenos Tratamiento local Resistente a la castración No resistente a la castración Cuidados paliativos
CHEMOTHERAPY HORMONE THERAPY RADIOISOTOPES BONE METS VISCERAL METS BIOMARKERS (PSA…)
Thuret et al. Ann Oncol 2008
Practical recommendation: DO NOT TRUST PSA in the first 12 weeks of therapy (in the absence of clinical deterioration) Conteduca et al. Prostate 2017
Sonpavde et al. Eur Urol 2016
RECIST CRITERIA Bone lesions are non-measurable Blastic bone lesions are non-measurable Lytic or mixed bone lesions with soft tissue component can be measurable
Radiographic progression without PSA progression does happen (PREVAIL) PREVAIL trial: Enzalutamide vs placebo in mCRPC chemo-naïve asymptomatic patients Radiographic progression without PSA progression: 24.5% (62/265 patients) Should we perform imaging tests even if PSA is not progressing?
In CRPC, PSA is not always reliable… and RECIST criteria are not useful in the majority if patients
Scher et al. J Clin Oncol 2016
Scher et al. J Clin Oncol 2016
Scher et al. J Clin Oncol 2016
NLCB: no longer clinically benefiting Scher et al. J Clin Oncol 2016
Crawford et al. Urology 2017
Crawford et al. Urology 2017
Crawford et al. Urology 2017
PROGRESSION PSA CLINICAL TOXICITY IMAGES
CHEMO RADIUM HORMONE Fit enough for it Visceral metastases No visceral metastases The earlier the better Symptomatic RADIUM “Always” fit for it Asymptomatic HORMONE
SWITCH TOO EARLY Loss of benefit SWITCH TOO LATE Loss of oportunity
CONCLUSIONS “No longer clinically benefiting” as the new definition for progression PSA / Radiographic / Clinical The role of new imaging techniques is expanding, but… DON’T SWITCH TOO EARLY DON’T WAIT TOO LONG
MUCHAS GRACIAS POR SU ATENCIÓN ÁLVARO PINTO Servicio de Oncología Médica Hospital Universitario La Paz – IdiPAZ, Madrid