Neuroendocrine prostate cancer and MLN8237 (alisertib)

Neuroendocrine prostate cancer or NEPC is an aggressive, late stage form of castration-resistant prostate cancer (CRPC) with a very poor prognosis. Most patients will live for less than 12 months after diagnosis with NEPC.

NEPC is diagnosed in about 25 percent of men with CRPC, and so its impact on prostate cancer-specific mortality is considerable, but its diagnosis is not simple; it is only now being widely recognized as a significant factor in the management of men with late-stage disease; and as yet we have no forms of treatment approved specifically to treat this subtype of CRPC.

On the Medscape Oncology web site you can find a short interview with Dr. Himisha Beltran, Assistant Professor of Medicine at Weill Cornell Medical College and Assistant Attending Physician at New York-Presbyterian Hospital.  Dr Beltran is overseeing an ongoing Phase II trial of a drug known as alisertib or MLN8237 (a so-called aurora kinase inhibitor) in the treatment of men with metastatic, castration-resistant NEPC.

According to Dr. Beltran:

NEPC should be suspected in patients who develop rapidly progressive disease or visceral disease such as liver metastases or brain metastases in the setting of low prostate-specific antigen (PSA). In those cases, biopsies should be considered to confirm or rule out NEPC. An important reason to be aware of the possibility of NEPC and to actively look for it is that drugs that target androgen receptor signaling are less likely to be effective in NEPC. That is an important implication for being able to select patients for individualized treatment.

2 Responses

  1. paciente con adenocarcinoma prostatico metastasis osea con expresion de cromogranina resistente a la castración. enfermedad en avance luego de tratamiento con docetaxel , zoladex, y enzalutamida.
    que tratamiento pudiera seguir.

  2. Maria Elena:

    I think you are saying that you are helping a patient with prostate cancer who has bone metastasis and is castration-resistant and has progressive disease after treatment with docetaxel, Zoladex, and enzalutamide too. And you want to know what other treatments might be available. Yes?

    Effective treatments for such patients are not really available yet unless he can participate in a clinical trial for a drug like galeterone or alisertib, or perhaps ask his doctor whether he is an appropriate candidate for treatment with olaparib (Lynparza). If he is having bone pain then it may be possible to manage that pain with a drug like radium-223 (Xofigo).

    [Los tratamientos eficaces para este tipo de pacientes no están realmente disponibles aún menos que pueda participar en un ensayo clínico de un medicamento como alisertib o galeterone, o tal vez pida a su médico si él es un candidato adecuado para el tratamiento con olaparib (Lynparza). Si él está teniendo dolor en los huesos, entonces puede ser posible manejar ese dolor con un medicamento como radium-223 (Xofigo).]

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