BRCA Prostate Cancer: Lessons Learned from a Successful Outcome
On March 29, 2016, we reported the story of a 55 year old man diagnosed 13 years earlier with prostate cancer who had failed many prior courses of therapy.
When our functional profile performed on a surgical biopsy revealed an unexpected degree of activity for platinum-based chemotherapy, I decided to pursue the possibility that this patient’s tumor might carry a mutation in the BRCA genes.
I referred him to a genetic counselor who conducted a genomic screen to rule out familial (hereditary) BRCA mutation. These results proved to be negative.
Based upon our laboratory functional profiling results however, my suspicions remained high and I submitted a second analysis that specifically examined his cancerous tissue (not his blood) for the BRCA mutation that was not identified by the first test.
Our determination paid off as his prostate tumor tissue proved positive for BRCA. Thus the platinum sensitivity identified in our laboratory, characteristic of BRCA patients, led us to the correct diagnosis of BRCA positivity.
At the time of my March 29th blog, I wrote that we had petitioned the insurers to provide the patient Olaparib (Lynparza™), the first FDA approved PARP inhibitor that is used for the treatment of BRCA patients.
As the request was somewhat unusual, with most BRCA patients being women with breast and ovarian cancer, procuring the drug for a BRCA prostate cancer patient took some legwork. Nonetheless, we ultimately prevailed and the patient received his first cycle of this simple oral therapy beginning in mid-April.
I am delighted to report that my recent visit with this patient and his wife could not have been a happier occasion.
Only three weeks after starting oral Olaparib, the patient’s very firm and enlarged left neck lymph node was demonstrably smaller, his prostatic acid phosphatase (PAP), a measure of prostate cancer, had fallen from 43 to 13.9 (normal 0-4) and his PSA, another prostate cancer test, from 26 to 13 (normal 0-4)
Although he complained of some fatigue, he has been spared the hair loss, nausea, vomiting and bone marrow suppression that is so commonly associated with classic chemotherapy treatments
This gratifying response to a simple oral medication reflects the growing recognition that each patient must be treated with those drugs and/or combinations that are found effective for their unique disease.
Without the insights gained from our laboratory analyses, this BRCA prostate cancer patient would be now confronting the grim prospect of ineffective and toxic chemotherapy or worse still, disease progression. We are delighted with his good results.
As always, I welcome your questions and comments.
Dr. Robert Nagourney, has been internationally recognized as a pioneer in cancer research and personalized cancer treatment for over 20 years. He is a TEDX SPEAKER, author of the book OUTLIVING CANCER, a practicing oncologist and triple board certified in Internal Medicine, Medical Oncology and Hematology helping cancer patients from around the world at his Nagourney Cancer Institute in Long Beach, California. For more info go to NAGOURNEYCANCERINSTITUTE.COM