Dr. Przemyslaw Twardowski's Case Study

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

Dr przemyslaw

Not actual patient.

Dr. Przemyslaw
Twardowski's Case Study

Initial Presentation1

  • Age 53
  • PSA 65.4 ng/mL
  • Family history of prostate cancer (father)
  • Prostate cancer exam–remarkable for diffuse, bilateral induration and nodules
  • Ultrasound-guided prostate biopsy Gleason grade 5+5=10 adenocarcinoma
  • No evidence of neuroendocrine differentiation
  • Bone scan revealed skeletal metastases
  • CT of the abdomen
    • Unexpectedly revealed sclerotic bone metastases
    • No lymphadenopathy
    • No visceral lesions
  • Baseline scan1:
    Sagittal views of CT scan reveal sclerotic lesions in the spine

Patient Treatment History


Initial Management1

  • Initiated CAB (leuprolide + bicalutamide) treatment
  • 12 months after initiating therapy, PSA nadirs
  • 6 months later, patient progressed to mCRPC
    • PSA 20.4 ng/mL
    • Bone scan revealed new osseous metastases
    • Patient developed pain in lower back and rib cage

Subsequent Management:

  • Androgen deprivation therapy (ADT)* continued and treatment of docetaxel + prednisone initiated
  • Denosumab at 120 mg subcutaneously every 4 weeks also initiated

*ADT is maintained throughout mCRPC treatment.

Patient progressed to mCRPC

First-Line Therapy: Docetaxel + Prednisone1

Response to Treatment:

  • PSA initially declined
  • Scans stable
  • Bone pain resolved
  • Patient experienced the following adverse events:
    • Alopecia
    • Fatigue
    • Nail changes

Disease Progression:

  • Experienced biochemical progression with PSA rise after 6 cycles
  • Patient again experiences bone pain
  • Minor changes in bone scan
  • CT scan stable
  • Docetaxel is discontinued in view of clinical and PSA progression

Patient's disease progressed

Second-Line Therapy: Enzalutamide1

Response to Treatment:

  • PSA continued to rise
  • Patient experienced the following:
    • Rise in alkaline phosphatase from 172 to 530 within 2 months
    • Fatigue
    • Progressive pain in back and leg

Disease Progression:

  • PSA progression
  • Clinical progression
    • Worsening pain in lower back, radiating to right leg and eventually requiring opioids
  • Enzalutamide discontinued
  • Germline testing and next-generation sequencing tumor testing conducted
    • No actionable mutations revealed
    • Tumor harbored TMPRSS2-ETV4 fusion

Patient's disease progressed

After Discontinuation of Enzalutamide1

  • Staging scans performed after treatment discontinuation revealed likely radiographic progression
    • CT revealed likely progression of bony metastases
    • Bone scan difficult to interpret progression due to extensive baseline but no new osseous metastases noted
  • Palliative radiation therapy (RT) to lumbosacral spine in 10 fractions initiated
  • Opioids discontinued because of palliative RT result

Dr. Przemyslaw Twardowski's Treatment Choice: JEVTANA

Read Below to See Why Dr. Przemyslaw Twardowski 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 with granulocyte-colony stimulating factor (G-CSF).

RATIONALE for Treatment2

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

Clinical Outcome and Follow-Up1

  • PSA stable after 2 cycles
  • Patient was counseled on all possible AEs. Please refer to Prescribing Information for full list of potential AEs
  • The patient experienced the following AEs at last assessment post-cycle 2:
    • Grade 1 diarrhea
    • Grade 1 fatigue
  • Patient continued treatment

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; CAB=combined androgen blockade; CT=computed tomography; mCRPC=metastatic castration-resistant prostate cancer; PSA=prostate-specific antigen; rPFS=radiographic progression-free survival.