VALORACIÓN DE RESPUESTA EN CPRC METASTÁSICO

Presentación del tema: "VALORACIÓN DE RESPUESTA EN CPRC METASTÁSICO"— Transcripción de la presentación:

1 VALORACIÓN DE RESPUESTA EN CPRC METASTÁSICO
ÁLVARO PINTO Servicio de Oncología Médica Hospital Universitario La Paz – IdiPAZ, Madrid

2 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

3

4 CHEMOTHERAPY HORMONE THERAPY RADIOISOTOPES BONE METS VISCERAL METS BIOMARKERS (PSA…)

5 Thuret et al. Ann Oncol 2008

6 Practical recommendation:
DO NOT TRUST PSA in the first 12 weeks of therapy (in the absence of clinical deterioration) Conteduca et al. Prostate 2017

7 Sonpavde et al. Eur Urol 2016

8 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

9 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?

10 In CRPC, PSA is not always reliable… and RECIST criteria are not useful in the majority if patients

11 Scher et al. J Clin Oncol 2016

12 Scher et al. J Clin Oncol 2016

13 Scher et al. J Clin Oncol 2016

14 NLCB: no longer clinically benefiting
Scher et al. J Clin Oncol 2016

15 Crawford et al. Urology 2017

16 Crawford et al. Urology 2017

17 Crawford et al. Urology 2017

18 PROGRESSION PSA CLINICAL TOXICITY IMAGES

19

20 CHEMO RADIUM HORMONE Fit enough for it Visceral metastases
No visceral metastases The earlier the better Symptomatic RADIUM “Always” fit for it Asymptomatic HORMONE

21 SWITCH TOO EARLY Loss of benefit SWITCH TOO LATE Loss of oportunity

22 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

23

24 MUCHAS GRACIAS POR SU ATENCIÓN
ÁLVARO PINTO Servicio de Oncología Médica Hospital Universitario La Paz – IdiPAZ, Madrid