Dr. Neal Shore's Case Study

Read Through the Following Patient Treatment History to See What Treatment Option Dr. Neal Shore Selected at Each Line of Therapy

Dr Neal

Not actual patient.

Dr. Neal Shore's
Case Study

Initial Presentation1

  • Age 66
  • Patient presents with elevated PSA after a routine screening in 2013
  • Medical history of deep vein thrombosis, hypertension, and erectile dysfunction
  • Family history of prostate cancer–father died from prostate cancer at age 80, 2 brothers have prostate cancer
  • Germline testing: positive BRCA1
  • PSA 8.2 ng/mL
  • Digital rectal examination–enlarged hard prostate
  • Transrectal biopsy–Gleason grade 4+4=8
  • pT2N0m0
  • Bone scan–negative
  • CT of abdomen/pelvis–negative

Patient Treatment History


Initial Management1

  • Radical prostatectomy
  • Lost to follow-up and presents 5 years later in 2018
    • PSA 17.3 ng/mL
    • Scans negative
    • Leuprolide initiated and PSA initially declined
  • Disease progression after 12 months
    • PSA 30.4 ng/mL
    • Bone scan: two rib lesions and two spine lesions
    • CT scan: extensive abdominal and pelvic adenopathy

Subsequent Management:

  • Based on progression to mCRPC, initiated treatment of enzalutamide
  • Androgen deprivation therapy (ADT) is maintained throughout mCRPC treatment

Patient progressed to mCRPC

First-Line Therapy: Enzalutamide1

Response to Treatment:

  • PSA nadir 5.07 ng/mL
  • Decrease of abdominal and pelvic adenopathy
  • Patient experienced the following AEs:
    • Grade 1 fatigue
    • Arthralgia

Disease Progression at 12 Months (2019):

  • PSA increased to 10.0 ng/mL
  • Radiographic progression: bone scan showed new lesions at lumbar spine, pelvis, and bilateral femoral
  • Enzalutamide discontinued

Subsequent Management:

  • Initiated on docetaxel 75 mg/m2 every 3 weeks with prednisone 10 mg daily

Patient's disease progressed

Second-Line Therapy: Docetaxel + Prednisone1

Response to Treatment:

  • PSA nadir 7.13 ng/mL
  • Decrease of lesions in skull, ribs, sternum, spine, and femur
  • Patient experienced the following AEs:
    • Diarrhea
    • Nausea
    • Neutropenia
    • Fatigue
    • Alopecia
  • Patient discontinued after 6 cycles due to cumulative toxicities

Treatment was discontinued after 6 cycles

After Discontinuation of Docetaxel + Prednisone1

  • Patient continued on androgen deprivation therapy only after docetaxel
  • 5 months after discontinuation, PSA increased to 30.0 ng/mL
  • Radiographic progression was documented

Patient's disease progressed

Dr. Neal Shore's Treatment Choice: JEVTANA

Read Below to See Why Dr. Neal Shore Chose JEVTANA as the Next Line of Therapy for His Patient

Treatment selection1

Patient started on JEVTANA 20 mg/m2 every 3 weeks and prednisone.

RATIONALE for Treatment2

Based on patient disease characteristics and treatment progression, Dr. Shore referred to the CARD trial. In the CARD trial, JEVTANA provided 2x rPFS vs a second ASTI.

Clinical Outcome and Follow-Up1

  • PSA decreased to 10.1 ng/mL
  • Scans demonstrated no disease progression
  • Patient experienced the following AEs:
    • Grade 1 fatigue
    • Grade 2 neutropenia
      • Granulocyte-colony stimulating factor (G-CSF) initiated
    • Cachexia
    • Dysgeusia
  • Patient continued treatment
  • Patient was counseled on all possible AEs. Please refer to Prescribing Information for full list of potential AEs

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.
AEs=adverse events; ASTI=androgen-signaling-targeted inhibitor; CT=computed tomography; mCRPC=metastatic castration-resistant prostate cancer; PSA=prostate-specific antigen; rPFS=radiographic progression-free survival.