VALORACIÓN DE RESPUESTA EN CPRC METASTÁSICO

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Transcripción de la presentación:

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