Affiliation:
1. Division of Medical Oncology & Hematopoietic Cell Transplant Unit, Department of Medicine, ''Metaxa'' Cancer
Hospital, 51 Botassi Street, 18537 Piraeus, Greece
2. Department of Radiation Oncology, Metaxa Cancer Hospital,
Piraeus, Greece
Abstract
Background:
Background: Metastatic castrate-resistant prostate cancer (mCRPC) is a challenging
disease, especially in heavily pretreated patients. Androgen pathway inhibitors have contributed to
a notable improvement in the overall survival and quality of life in patients with mCRPC during the
last decade. Still, a considerable percentage of patients are unable to draw benefits from this drug
category and are deprived of a treatment that offers limited toxicity and preserves a good quality of
life. The mechanisms leading to this pre-existing or acquired resistance, as well as the possible
strategies to overcome this resistance have been put at the center of scientists’ attention.
Case Presentation:
With the present report we present the case of a 70-year-old patient with
mCRPC, who was apparently an enzalutamide non-responder, but a multimodal approach with
enzalutamide continuation and irradiation to his symptomatic oligoprogressive disease converted
him to a responder with clinical, biochemical and imaging response; furthermore, we discuss the
existing data providing evidence for the use of metastasis-directed therapy in combination with
androgen pathway inhibitors in order to overcome drug resistance in patients with oligoprogressive
disease.
Conclusion:
A considerable proportion of patients with oligometastatic or oligoprogressive
prostate cancer who seem not to respond to androgen pathway inhibitors, such as enzalutamide, due
to preexisting or acquired resistance, could benefit from MDT with a multimodal treatment
approach. This strategy allows androgen pathway inhibitor continuation beyond biochemical
progression and delays the switch to next-line systemic treatment.
Publisher
Bentham Science Publishers Ltd.
Subject
Pharmacology,General Medicine