Prostate Cancer Neuroendoctine Diffesrentiation small cell morphology

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This topic contains 4 replies, has 2 voices, and was last updated by catdander forum moderator catdander forum moderator 6 months, 1 week ago.

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December 9, 2017 at 11:27 am  #1293616    

benmaclean

Hello All

I am trying to find resources re the above, and I am wondering with the paucity of information I have so far found specifically for this type of disease how “fungible” SCLC treatment options are for this disease – any pointers greatfuly received.

My father in law (the patient) is 76yo and has a “medium”performance score due to preexising circulatory issues with his legs (multiple surgeries etc) and severe lymphodema re both circulation issues + lymphadenopathy re PC.

He has been transferred to the lung specialist because of the small cell morphology.

He has had 4 cycles of PE and whilst the first two cycles gave some good pallation of oedema in particular – this is now regressing. Recent scan shows stable disease in pelvis, new lymphadenopathy outside the field has started to show itself (neck nodes).

Whilst we don’t have the write up up – the onvologist didn’t see any visceral metastases – though peritoneal lymphadenopathy as increased.

So to the crux / our oncologist has suggested we complete 6 cycles of PE – and then either do nothing/best supportive care, or try CAV, which given my Father in laws frail condition worried me.

I was suprised neither taxanes or maybe topotevan monotherapy weren’t given as options.

I think most CTLA-4/PD-1/PDL-1 options are not approved by NICE for NEPC, and I fear any trials will be closed to him re PS/comorbiditiies – so where next?

Thanks

Ben

December 10, 2017 at 10:08 am  #1293617    
catdander forum moderator
catdander forum moderator

Hi Ben,

Welcome to Grace. I’m sorry to about your father in law. Unfortunately we don’t have expert mediated resources on prostate cancer however it’s not uncommon for those with rare small cell carcinoma with a morphology outside the lung to be referred to a small cell expert. However there remains a pitifully small amount of treatment options for sclc with cisplatin/etoposide still the norm. There are other single agents given after first line platinum that have shown some efficacy in 2nd line treatment of sclc. It would be appropriate to speak or have your father in law speak to the oncologist about these single agent treatments. The following post is from 2007 but still applies for sclc and would be worth discussing the oncologist (note the links at the bottom of the post), http://cancergrace.org/lung/2007/01/07/treatment-of-recurrent-sclc/

From ASCO Daily News Dr. Rahul Aggarwal describes 2 related but differently treated NEPCs, “Patients presenting with de novo pure small cell carcinoma arising from the prostate gland, a rare entity observed in approximately 1% of all prostate cancer cases, should be treated with a platinum plus etoposide combination similar to the treatment for small cell lung cancer.” https://am.asco.org/daily-news/treatment-systemic-neuroendocrine-prostate-cancer

The following link is to a trial testing PD-L1 inhibitor immunotherapy being held at Duke Univ in NC.

https://clinicaltrials.gov/ct2/show/NCT03179410?cond=nepc&rank=1

You are thoughtful to question whether CAV would likely provide a benefit that outweighs possible side effects and a conversation to be had with the oncologist.

I wish there were more to offer.
All best to you and your family,
Janine

December 10, 2017 at 10:23 am  #1293619    
catdander forum moderator
catdander forum moderator

Our search engine is down for the weekend but you can search using google by starting the search with site:cancergrace.org then use a space before adding your search topic. Here is another generic sclc link, http://cancergrace.org/lung/tag/small-cell-lung-cancer/

December 11, 2017 at 2:46 am  #1293622    

benmaclean

Thank you so much for the reply. I did attempt searches – at least I know why I couldn’t find stuff now.

Will be working with (on) the oncologist to consider oral Topotecan. TBH I am now more worried re CAV than I was previously. Having looked up oral Topotecan on the NICE website I can see it’s only approved where CAV is contraindicated. So I takes a look (just in case) at what the contras ar for the components – “Cyclophosphamide is contraindicated in patients with urinary outflow obstruction” and generally note the cystotoxicity if this agent. My FIL can’t piss a thimble full (slight exaggeration).

Once again many thanks

Ben

December 11, 2017 at 4:58 am  #1293624    
catdander forum moderator
catdander forum moderator

It’s appropriate to discuss the concerns for a particular treatment with the oncologist. With the high toxicity rate of these drugs the benchmarks are set pretty low for contraindication. On the other hand some people can breeze through treatments while others in better health have a difficult time.
Your father in law is lucky to have you.
Best of luck,
Janine

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