1. A patient’s view on mCRPC What to tell our fellow patients!
Rik Cuypers, patients association Wij Ook Belgium vzw
US Too Belgium non-profit-org.
Personal ideas, not necessarily reflecting the association’s point of view.
Questions and remarks at any time
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2. I know nothing, I’m from Antwerp
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3. Patient’s needs Facility with the best, affordable, treatment
Best doctors and nurses
Quality of life priority
Information
Emotional support
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4. Imelda 13 september 2014 - Patiënteninspraak - Rik Cuypers
Medical history of Rik
Healthy life. Checked as military pilot. Sportslike
Diagnosed mPC in 2001 – 58 years
T3b, Gleason 8, Fracture in L5 vertebrae, Nerve compression
LHRH, 30 Gy on 2 mets , Bisphosphonate
2007 PSA 7, Androgen receptor blocker
2015 PSA 154, mets in spine, ribs, lungs, liver
2015 Abiraterone, PSA < 0.1, mets ondetectable size
Imelda 13 september Patiënteninspraak - Rik Cuypers

5. mCRPC Metastatic when diagnosed or
Recurrence after treatment of local PC or localy advanced PC
Castrate resistance (questionable notion) Therapy resistance, after a testosterone reduction below 1,7 nmol/l
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6. When CR? (activity suppressed or dormant)
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7. Londen EAU 2017 – Wij ook vzw

8. Initial hormone treatment of mPC
ADT (Androgen deprivation therapy)
GnRH (agonist or antagonist) 1st line (combined with chemo on start-up)
Bilateral orchiectomy (again?) 1st line
Androgen receptor blocking nd line
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9. Advanced treatment of mCRPC
Sequencing or combining; cross over.
Knowledge of the cellular, biochemical, molecular, and genetic mechanisms
Available treatments, FDA, EMA, country dependant
Clinical trials fase III and “expanded access programs” or “compassionate use” availability
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10. Todays readily available treatment of mCRPC
METASTASE
Castrate resistant
Hormone naive
DEVELOPS INTO
Not fit: ADT
Fit: ADT + chemo
Abiraterone Enzalutamide
Solid mets:
Radium 223
Chemo
Sequencing, cross over, and combining
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11. Advanced treatments of mCRPC
3rd line ADT (abiraterone, enzalutamide)
Chemotherapy (docetaxel, cabazitaxel)
Immunotherapy (sipuleucel-T, prostvac)
Immune checkpoint inhibitor activating the T-cells, (pembrolisumab)
Targeted therapy PARP, DNA repair inhibitor (olaparib)
Radiopharmaceuticals (radium-223 a, PSMA actinum-225 a, PSMA lutetium-177 b)
External radiotherapy of oligomet
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12. Imelda 13 september 2014 - Patiënteninspraak - Rik Cuypers
Adverse and toxic effects. Loss of effectiveness Often not the first priority of the doctor
All treatments are palliative; work for a limited time only
Emotional disturbance due to trauma and to treatment
Destruction of healthy cells as well
Direct effects (e.g. testosterone suppression and libido)
Indirect effects (e.g. biochemical functioning of the body)
Combination of treatments with same side effects
Imelda 13 september Patiënteninspraak - Rik Cuypers

13. Thank you for the attention!
Londen EAU 2017 – Wij ook vzw