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Neoadjuvant chemotherapy for high-risk prostatic adenocarcinoma.

ABSTRACT: Introduction:Neoadjuvant chemotherapy in high-risk, locally advanced prostate cancer remains an understudied area of prostate cancer. Chemotherapy continues to be a viable option. The combination with surgery may be desired but lacks data for complete recommendation. Case presentation:We demonstrate the successful utilization of chemotherapy in the neoadjuvant arena. A 70-year-old male was diagnosed with high-risk prostate cancer on biopsy. Upon multiparametric magnetic resonance imaging, the patient had local rectal wall invasion and stage T4 N0 M0 after a negative bone scan. After treatment with androgen-deprivation therapy and docetaxel, repeat multiparametric magnetic resonance imaging showed regression of rectal invasion. The patient elected for prostatectomy and avoided proctectomy and colostomy. The patient's postoperative prostate-specific antigen was undetectable on initial follow-up. Conclusion:We show that neoadjuvant chemotherapy merits further study and may provide a more permanent surgical option for patients.

SUBMITTER: Brunner R

PROVIDER: S-EPMC7292178 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Neoadjuvant chemotherapy for high-risk prostatic adenocarcinoma.

Brunner Robert R Buck Bradley B Giffen Zane Z Murtagh Daniel D Lewis Terrence T Gatto-Weis Cara C Sindhwani Puneet P

IJU case reports 20190128 2

<h4>Introduction</h4>Neoadjuvant chemotherapy in high-risk, locally advanced prostate cancer remains an understudied area of prostate cancer. Chemotherapy continues to be a viable option. The combination with surgery may be desired but lacks data for complete recommendation.<h4>Case presentation</h4>We demonstrate the successful utilization of chemotherapy in the neoadjuvant arena. A 70-year-old male was diagnosed with high-risk prostate cancer on biopsy. Upon multiparametric magnetic resonance ...[more]

PMID: 32743374

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Project description:Current treatment for patients with locally advanced esophageal adenocarcinoma (EAC) is neoadjuvant chemotherapy (nCT), alone or combined with radiotherapy, before surgery. However, fewer than 30% of treated patients show a pathologic complete response to nCT, which correlates with increased 5-year survival compared with nonresponders. Understanding the mechanisms of response to nCT is pivotal to better stratify patients and inform more efficacious therapies. Here, we investigated the immune mechanisms involved in nCT response by multidimensional profiling of pretreatment tumor biopsies and blood from 68 patients with EAC (34 prospectively and 34 retrospectively collected), comparing complete responders versus nonresponders to nCT. At the tumor level, complete response to nCT was associated with molecular signatures of immune response and proliferation, increased putative antitumor tissue-resident memory CD39+ CD103+ CD8+ T cells, and reduced immunosuppressive T regulatory cells (Treg) and M2-like macrophages. Systemically, complete responders showed higher frequencies of immunostimulatory CD14+ CD11c+ HLA-DRhigh cells, and reduced programmed cell death ligand 1-positive (PD-L1+) monocytic myeloid-derived suppressor cells, along with high plasma GM-CSF (proinflammatory) and low IL4, CXCL10, C3a, and C5a (suppressive). Plasma proinflammatory and suppressive cytokines correlated directly and inversely, respectively, with the frequency of tumor-infiltrating CD39+ CD103+ CD8+ T cells. These results suggest that preexisting immunity in baseline tumor drives the clinical activity of nCT in locally advanced EAC. Furthermore, it may be possible to stratify patients based on predictive immune signatures, enabling tailored neoadjuvant and/or adjuvant regimens.SignificanceMultidimensional profiling of pretreatment esophageal adenocarcinoma shows patient response to nCT is correlated with active preexisting immunity and indicates molecular pathways of resistance that may be targeted to improve clinical outcomes.

Dataset Information

Neoadjuvant chemotherapy for high-risk prostatic adenocarcinoma.

Publications

Neoadjuvant chemotherapy for high-risk prostatic adenocarcinoma.

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