Dr. Nicholas Vogelzang's Case Study

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

Dr Nicholas

Not actual patient.

Dr. Nicholas Vogelzang's
Case Study

Initial Presentation1

  • Age 75
  • Patient presents with elevated PSA during routine screenings
  • Prostate biopsy confirmed diagnosis of prostate adenocarcinoma
  • Medical history of hypertension, diabetes mellitus, and hyperlipidemia

Patient Treatment History

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Initial Management1

  • Patient underwent radical prostatectomy
    • Prostatic adenocarcinoma, Gleason grade 4+3=7
    • Seminal vesicles positive bilaterally
    • Extracapsular extension present at the left posterior margin
    • Focal perineural invasion present
    • Bladder neck and circumferential margins negative for tumor
    • Urethra, anterior margin, positive for small focus of prostatic adenocarcinoma
    • Final pathology, pT3b pNx
  • Patient received radiotherapy with concurrent leuprorelin therapy for 6 months
    • PSA undetectable following therapy

Progression to Metastatic Disease:

  • Post-therapy progression after 8 years
    • Patient developed mild low back pain
    • CT and bone scan both showing diffuse metastatic disease in the spine
    • PSA 30.2 ng/mL

Initial Management of Metastatic Disease:

  • Started on leuprolide, abiraterone, and prednisone

First-Line Therapy: Abiraterone + Prednisone1

Response to Treatment:

  • Patient responded initially with PSA undetectable at 5 months
  • Patient experienced the following:
    • Grade 1 fatigue
    • Grade 2 hypertension treated by increasing amlodipine dose
  • Patient reported back pain

Disease Progression:

  • 9 months on therapy; PSA increased to 35.5 ng/mL
  • Bone scan 2 months later showed progressive disease with increased uptake predominantly in the lumbar spine and upper manubrium
  • Back pain worsened
  • Abiraterone discontinued

Subsequent Management:

  • Androgen deprivation therapy continued and patient was started on docetaxel 75 mg/m2 every 3 weeks and prednisone

Patient progressed to mCRPC

Second-Line Therapy: Docetaxel + Prednisone1

Response to Treatment:

  • PSA continued to increase each cycle
    • Cycle 1, baseline of 54.3
    • Cycle 2, PSA 141.78 ng/mL prior to cycle 2
    • Cycle 3, PSA 143.25 ng/mL prior to cycle 3
    • Cycle 4, PSA 164.75 ng/mL prior to cycle 4
    • PSA increased to 304.37 ng/mL prior to cycle 5
  • Patient experienced the following AEs:
    • Alopecia
    • Fatigue
    • Neutropenia without fever after cycle 1
  • Patient reported progressive low back pain
  • Bone scan showed progressive uptake in the spine and manubrium
  • CT simulation showed large metastasis in L4 extending into bilateral pedicles with central canal narrowing. No epidural tumor identified. Second large metastasis noted in T12
  • Docetaxel is discontinued after 4 cycles
  • Palliative radiation therapy to T12 through L4: 20 Gy in 5 fractions initiated

Dr. Nicholas Vogelzang's Treatment Choice: JEVTANA

Read Below to See Why Dr. Nicholas Vogelzang 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. Vogelzang referred to the CARD trial. In the CARD trial, JEVTANA provided 2x rPFS vs a second ASTI.

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.