Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (4): 766-769. doi: 10.19723/j.issn.1671-167X.2022.04.030

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Bipolar androgen therapy followed by immune checkpoint inhibitors in metastatic castration resistant prostate cancer: A report of 4 cases

Sheng-jie LIU,Hui-min HOU,Zheng-tong LV,Xin DING,Lu WANG,Lei ZHANG,Ming LIU*()   

  1. Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinses Academy of Medical Sciences, Beijing 100070, China
  • Received:2022-03-15 Online:2022-08-18 Published:2022-08-11
  • Contact: Ming LIU E-mail:liuming19731029@163.com
  • Supported by:
    the National Natural Science Foundation of China(81900700);Beijing Hospital Clinical Research Sailing Project(BJ-2022-157)

Abstract:

The relationship between androgen and prostate cancer treatment has plagued the field of urologic oncology. To investigate the efficacy and safety of bipolar androgen therapy (BAT) followed by immune checkpoint inhibitor therapy in patients with metastatic castration resistant prostate cancer (mCRPC). In August 2020, Beijing Hospital conducted an investigator-initiated study: Bipolar androgen therapy followed by immune checkpoint inhibitor therapy in metastatic castration resistant prostate cancer. Up to now, the study has included 4 patients who completed the entire cycle of treatment. The mean age of the patients was 74.5 (68 to 82) years old, the mean prostate-specific antigen (PSA) was 20.8 (9.9 to 8.36) μg/L, the mean testosterone was 0.50 (0.00 to 1.81) μg/L, and the Gleason score were 10 and 9, 7, 7 respectively. The pain scale score before treatment was 1.5 (1 to 2). In this study, 4 patients completed the entire cycle of treatment, and the treatment effect of the patients showed great heterogeneity. PSA in case 1 decreased from 24.0 μg/L to 0.47 μg/L, testosterone increased from 0.175 6 μg/L to 2.62 μg/L. PSA in case 2 increased from 9.939 μg/L to 168.536 μg/L, and testosterone increased from 0.0 μg/L increased to 2.85 μg/L. PSA increased from 13.31 μg/L to 39.278 μg/L in case 3, testosterone increased from 0.0 μg/L to 2.54 μg/L. and PSA increased from 36.0 μg/L to 350.2 μg/L in the case 4, testosterone increased from 1.81 μg/L to 3.85 μg/L. Except for one patient who showed significant PSA remission, the PSA levels of the remaining three patients remained high overall. There were no adverse reactions reported in 4 patients. In the follow-up, case 1 continued to use PD-1 monoclonal antibody (median progression free survival time was 10 months). Two patients who had previously been resistant to enzalutamide received enzalutamide again after the whole cycle of treatment, and their PSA decreased again, which indicated that the patient was sensitive to enzalutamide again. BAT had a certain therapeutic effect on mCRPC patients, and the safety was controllable. Its tumor control effect still needed long-term follow-up verification in large-sample clinical trials. BAT has a certain therapeutic effect on mCRPC patient, especially the resensitivity of tumors to enzalutamide can be restored. Immune checkpoint inhibitors may have therapeutic potential in patients with prostate cancer treated with BAT and enzalutamide.

Key words: Prostate cancer, Bipolar androgen therapy, Immune checkpoint inhibitors, Efficacy, Safety

CLC Number: 

  • R737

Figure 1

Changes in PSA and testosterone after treatment in 4 patients enrolled in the study"

1 毕学翠. 北京2022年冬奥会运动员医疗保障前瞻: 基于2010年、2014年冬奥会运动员损伤情况分析[J]. 中国学校体育(高等教育), 2018, 5 (12): 81- 86.
2 王古岩, 郭向阳. 抗击新型冠状病毒肺炎疫情: 麻醉相关感染控制的改良[J]. 中华麻醉学杂志, 2020, 40 (3): 257- 261.
doi: 10.3760/cma.j.cn131073.20200213.00301
3 中华医学会麻醉学分会气道管理学组. 新型冠状病毒肺炎危重型患者气管插管术的专家建议(1.0版)[J]. 中华麻醉学杂志, 2020, 40 (3): 287- 290.
doi: 10.3760/cma.j.cn131073.20200218.00307
4 米卫东, 黄宇光, 孙立, 等. 新型冠状病毒肺炎疫情期间常规手术麻醉管理和防控流程建议[J]. 麻醉安全与质控, 2020, 4 (1): 9- 11.
5 北京协和医院新型冠状病毒感染的肺炎诊治专家组. 北京协和医院关于"新型冠状病毒感染的肺炎"诊疗建议方案(V2.0)[J]. 中华内科杂志, 2020, 59 (3): 186- 188.
doi: 10.3760/cma.j.issn.0578-1426.2020.03.003
6 李阳, 李占飞, 毛庆祥, 等. 新冠肺炎疫情期间严重创伤紧急手术及感染防护专家共识[J]. 中华创伤杂志, 2020, 36 (2): 97- 103.
doi: 10.3760/cma.j.issn.1001-8050.2020.02.001
7 中华人民共和国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第八版)[J]. 中国医药, 2020, 15 (10): 1494- 1499.
8 兰星, 杨磊, 伍静, 等. 新型冠状病毒肺炎流行期间麻醉科的感染控制: 武汉协和医院的经验[J]. 中华麻醉学杂志, 2020, 40 (3): 267- 270.
doi: 10.3760/cma.j.cn131073.20200224.00303
9 郭莉, 高兴莲, 常后婵, 等. 疑似或确诊新型冠状病毒肺炎患者手术室感染防控专家共识[J]. 中国感染控制杂志, 2020, 19 (5): 385- 392.
10 北京市医院感染质量控制和改进中心, 北京市临床麻醉质量控制与改进中心, 北京护理学会. 新型冠状病毒肺炎疫情期间围手术期感染防控措施(试行)[J]. 中华医院感染学杂志, 2020, 30 (17): 2592- 2594.
11 Davis E , Loiacono R , Summers RJ . The rush to adrenaline: drugs in sport acting on the beta-adrenergic system[J]. Br J Pharmacol, 2008, 154 (3): 584- 597.
doi: 10.1038/bjp.2008.164
12 武汉药学会《医疗机构含兴奋剂药品规范管理专家共识》编写组. 医疗机构含兴奋剂药品规范管理专家共识[J]. 医药导报, 2019, 38 (11): 1391- 1397.
13 Xuezhao C , Paul FW , Hong M . An update on the management of postoperative nausea and vomiting[J]. J Anesth, 2017, 31 (4): 617- 626.
doi: 10.1007/s00540-017-2363-x
14 Strzelecki A , Weafer J , Stoops WW . Human behavioral pharmacology of stimulant drugs: An update and narrative review[J]. Adv Pharmacol, 2022, 93, 77- 103.
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[1] . [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 434 -436 .
[2] . [J]. Journal of Peking University(Health Sciences), 2001, 33(3): 288 -289 .
[3] . [J]. Journal of Peking University(Health Sciences), 2002, 34(2): 97 -98 .
[4] . [J]. Journal of Peking University(Health Sciences), 2002, 34(2): 112 -116 .
[5] . [J]. Journal of Peking University(Health Sciences), 2011, 43(1): 29 -33 .
[6] . [J]. Journal of Peking University(Health Sciences), 2011, 43(2): 179 -182 .
[7] . [J]. Journal of Peking University(Health Sciences), 2009, 41(6): 635 -639 .
[8] . [J]. Journal of Peking University(Health Sciences), 2003, 35(4): 429 -433 .
[9] . [J]. Journal of Peking University(Health Sciences), 2003, 35(5): 485 -487 .
[10] . [J]. Journal of Peking University(Health Sciences), 2003, 35(z1): 92 -94 .