Berger Benjamin T, Labriola Matthew K, Antonarakis Emmanuel S, Armstrong Andrew J
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
BMJ Case Rep. 2023 Jan 18;16(1):e251320. doi: 10.1136/bcr-2022-251320.
We present the case of a patient with germline mutated metastatic castration-resistant prostate cancer (mCRPC) who responded to bipolar androgen therapy (BAT) combined with pembrolizumab after progressing through multiple lines of therapy. The patient was diagnosed in his 40s following an elevated screening prostate-specific antigen and biopsy. Over the course of 20 years, he progressed through nearly all standard therapies including androgen deprivation, combined androgen blockade, traditional chemotherapy, targeted therapies and experimental agents. He was ultimately treated with BAT, whereby the patient's cycle was between low (castrate) and high (supraphysiological) testosterone levels. This counterintuitive approach resulted in a marked response to BAT plus pembrolizumab consolidation lasting 13 months. His underlying germline mutation in , an important mediator of DNA repair, may have sensitised the cancer cells to the DNA damage caused by BAT. Single case report outcomes should not be used as evidence of efficacy for treatment regimes. Our case supports further investigation into BAT plus immunotherapy for patients with DNA repair-deficient mCRPC.
我们报告了一例患有生殖系突变的转移性去势抵抗性前列腺癌（mCRPC）患者的病例，该患者在接受多线治疗进展后，对双极雄激素疗法（BAT）联合派姆单抗有反应。该患者在40多岁时因筛查前列腺特异性抗原升高和活检而被诊断。在20年的病程中，他几乎经历了所有标准治疗，包括雄激素剥夺、联合雄激素阻断、传统化疗、靶向治疗和实验性药物。他最终接受了BAT治疗，患者的周期处于低（去势）和高（超生理）睾酮水平之间。这种违反直觉的方法导致对BAT加派姆单抗巩固治疗产生显著反应，持续了13个月。他潜在的生殖系 突变，一种DNA修复的重要介质，可能使癌细胞对BAT引起的DNA损伤敏感。单病例报告结果不应作为治疗方案疗效的证据。我们的病例支持对DNA修复缺陷的mCRPC患者进一步研究BAT加免疫疗法。
