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676 ALP and bone scan flare following enzalutamide treatment of castration resistant prostate cancer (CRPC) with bone metastasis
Title
676
ALP and bone scan flare following enzalutamide treatment of castration resistant prostate cancer (CRPC) with bone metastasis Eur Urol Suppl 2015;14/2;e676
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Hoshi S.H. 1 , Numahata K. 1 , Bilim V. 2 , Hoshi K. 3 , Kanto S. 3 , Sasagawa I.3 1 Yamagata
Prefectural Central Hospital, Dept. of Urology, Yamagata, Japan, 2 Niigata Cancer Center, Dept. of Urology, Niigata, Japan,
3 Yamagata
Tokusyuukai Hospital, Dept. of Urology, Yamagata, Japan
INTRODUCTION & OBJECTIVES: An increase in alkaline phosphatase activity has been described in patients with prostatic carcinoma within weeks of medical or surgical castration, and is believed to be of positive prognostic value for the success of systemic therapy. Measuring the flare in alkaline phosphatase activity within 1 month of orchiectomy may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from aggressive treatment. Ryan et al reported bone scan flare in 11 of 23 (48%) evaluable patients with abiraterone plus prednisone for metastatic and chemotherapy naive CRPC patients. No report was found about ALP flare following enzalutamide treatment. MATERIAL & METHODS: 40 patients of CRPC were treated with enzalutamide, 20 patients were chemotherapy naïve and 20 patients were chemotherapy resistant. RESULTS: 2 of 40(5%) patients were ALP flare. ALP began to increase 2 weeks after intiation of enzalutamide and peak at 4 weeks and began to decrease. PSA were decreased in both cases until 90%. Both cases decreased bone pain and became analgesic drugs free. In one case. PSA value decreased from 957 to 111 ng/ml and ALP value increased 382 IU/l to 1442 in 4 weeks and ALP decreased to 400 next 16 weeks. Bone scan flare was also found. The patient continued well and good ADL. CONCLUSIONS: A flare phenomenon, defined by an increase in skeletal radionuclide uptake, shortly after initiating hormonal therapy or chemotherapy was first described in the mid 1970s in patients with breast carcinoma metastatic to the skeleton using 87mstrontium and later 99mtechnetium bone scintigrams. This flare phenomenon has also been described in patients with prostate carcinoma metastatic to the skeleton 2 weeks after castration, with a return to baseline levels 2 months later. In patients with breast carcinoma metastatic to the skeleton a biochemical flare phenomenon in the form of an increase in serum alkaline phosphatase activity has also been described after hormonal therapy, chemotherapy or radiotherapy, and is reported to be of positive prognostic value for the success of systemic therapy. An increase in alkaline phosphatase activity has also been described in patients with prostatic carcinoma within weeks of medical or surgical castration, and is believed to be of positive prognostic value for the success of systemic therapy. Measuring the flare in alkaline phosphatase activity within 1 month of enzalutamide may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from this treatment.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/676.html[19/02/2015 08:18:28]
676
ALP and bone scan flare following enzalutamide treatment of castration resistant prostate cancer (CRPC) with bone metastasis Eur Urol Suppl 2015;14/2;e676
Print! Print!
Hoshi S.H. 1 , Numahata K. 1 , Bilim V. 2 , Hoshi K. 3 , Kanto S. 3 , Sasagawa I.3 1 Yamagata
Prefectural Central Hospital, Dept. of Urology, Yamagata, Japan, 2 Niigata Cancer Center, Dept. of Urology, Niigata, Japan,
3 Yamagata
Tokusyuukai Hospital, Dept. of Urology, Yamagata, Japan
INTRODUCTION & OBJECTIVES: An increase in alkaline phosphatase activity has been described in patients with prostatic carcinoma within weeks of medical or surgical castration, and is believed to be of positive prognostic value for the success of systemic therapy. Measuring the flare in alkaline phosphatase activity within 1 month of orchiectomy may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from aggressive treatment. Ryan et al reported bone scan flare in 11 of 23 (48%) evaluable patients with abiraterone plus prednisone for metastatic and chemotherapy naive CRPC patients. No report was found about ALP flare following enzalutamide treatment. MATERIAL & METHODS: 40 patients of CRPC were treated with enzalutamide, 20 patients were chemotherapy naïve and 20 patients were chemotherapy resistant. RESULTS: 2 of 40(5%) patients were ALP flare. ALP began to increase 2 weeks after intiation of enzalutamide and peak at 4 weeks and began to decrease. PSA were decreased in both cases until 90%. Both cases decreased bone pain and became analgesic drugs free. In one case. PSA value decreased from 957 to 111 ng/ml and ALP value increased 382 IU/l to 1442 in 4 weeks and ALP decreased to 400 next 16 weeks. Bone scan flare was also found. The patient continued well and good ADL. CONCLUSIONS: A flare phenomenon, defined by an increase in skeletal radionuclide uptake, shortly after initiating hormonal therapy or chemotherapy was first described in the mid 1970s in patients with breast carcinoma metastatic to the skeleton using 87mstrontium and later 99mtechnetium bone scintigrams. This flare phenomenon has also been described in patients with prostate carcinoma metastatic to the skeleton 2 weeks after castration, with a return to baseline levels 2 months later. In patients with breast carcinoma metastatic to the skeleton a biochemical flare phenomenon in the form of an increase in serum alkaline phosphatase activity has also been described after hormonal therapy, chemotherapy or radiotherapy, and is reported to be of positive prognostic value for the success of systemic therapy. An increase in alkaline phosphatase activity has also been described in patients with prostatic carcinoma within weeks of medical or surgical castration, and is believed to be of positive prognostic value for the success of systemic therapy. Measuring the flare in alkaline phosphatase activity within 1 month of enzalutamide may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from this treatment.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/676.html[19/02/2015 08:18:28]