PSA profile of patient with extended response to Xen1000 + En160.
pelvic lymphadenopathy, hypertension, prostate adenocarcinoma
METASTASIS, PELVIC LYMPHADENOPATHY, MAY, INTERMITTENT ATRIAL FIBRILLATION, PROSTATE ADENOCARCINOMA, HYPERTENSION, BONE METASTASES
The patient presented at age 64 in 2011 with PSA 83, bilateral prostate adenocarcinoma Gleason grade group 5 (4 + 5 = 9) and left acetabular metastasis on MRI scan. He was treated with leuprorelin, enzalutamide 160 mg daily was added in May 2015 but after initial PSA response there was PSA progression. CT scan May 2016 showed pelvic nodal progression (left pelvic side-wall node 19 × 15 mm, right external iliac and common iliac nodes, largest 16 × 14 mm). In November 2016, he was recruited to the Phase Ib expansion part of the trial. Baseline assessment showed ECOG PS 0, PSA 62.98, with increase in retroperitoneal and pelvic lymphadenopathy since May 2016. He remained on enzalutamide and weekly xentuzumab was added. Enzalutamide was dose reduced (120 mg daily) after he developed grade 1 QTc prolongation, intermittent atrial fibrillation and hypertension requiring adjustment of antihypertensive medication and anticoagulation (edoxaban 60 mg daily, replaced by aspirin 75 mg April 2021 after reversion to sinus rhythm). Xentuzumab infusions were interrupted April–August 2020 (due to COVID-related restricted access to the Trials Unit) and subsequently re-started. Trial treatment continues, scans showing pelvic nodes below size criteria with no evidence of bone metastases. Graph: PSA values prior to and on trial. Arrow: baseline PSA at trial entry. Dotted line: upper limit of normal. 