Comprehensive Cancer Testing and Treatment Options Review

“Testing and Treatment Options Review for Robert Ellis” (Robert Ellis) [#39] Brad Power January 11, 2023 “My main goal is to find some way of identifying more targetable markers that might give me more treatment options.

” Robert Ellis “What other things should I be talking to my doctor about or see if I can get lined up for after the current treatment that I'm on, after I stop responding to my current treatment?” Robert Ellis Meeting Summary Robert Ellis is an advanced prostate cancer patient who is looking for guidance on his treatment options and strategy after he stops responding to his current treatment.

In particular, he is interested in tests that could uncover biomarkers that would lead to targetable treatment options he could discuss with his doctor. What is Robert’s current situation? Robert was diagnosed in October 2017 with advanced prostate cancer – it had metastasized to his bones.

Over the last five or six years he has been through many rounds of treatment: several androgen deprivation therapy (ADT) drugs, focused radiation, immunotherapy, a PARP inhibitor, and chemotherapy. His disease, as measured by Prostate Specific Antigen (PSA) tests, which he has gotten as frequently as every three weeks, has risen and fallen three times.

He is currently on a hormone therapy (Orgovyx), a PARP inhibitor (Rubraca), a urination drug (dutasteride), and supplements, including metformin. His PSA is currently low (1.7).

He is considering two treatment options for his next line of treatment: (1) radiation particles targeted at Prostate Specific Membrane Antigen (PSMA), called “Pluvicto” or “Lutetium 177”, and (2) bipolar androgen therapy, where testosterone is introduced to the cancer cells which have been bred to survive in a hormone-deprived environment.

Robert’s priority for treatment is quality of life – enjoying his life, choosing approved drugs, not riskier treatments, low side effects, and not choosing treatments that would take a lot of time or travel to access. He is interested in drug combinations, intermittent treatments, and rechallenging. What additional testing options were suggested? ●Liquid biopsy, e.g.

, the Tempus xF+ test, can provide biomarkers for targeted treatments. ●Proteomic analysis, e.g., mProbe tissue analysis, can provide new biomarkers for targeted treatments.

“Testing and Treatment Options Review for Robert Ellis” (Robert Ellis) [#39] ●Standard Uptake Values from a PSMA PET scan will indicate whether he is likely to have a response to PSMA-targeted radiation therapy. ●Current status of PDL1/PD1, tumor mutation burden, and MSS/MSI, can help predict whether he will likely be responsive to immunotherapy.

●Whole genome and RNA sequencing can identify biomarkers which may be targetable. ●Bone biopsy, possibly the bone aspirate liquid biopsy being researched by Peter Kuhn, to be able to analyze bone tumors. What additional treatment options were suggested?

will likely be responsive to immunotherapy. ●Whole genome and RNA sequencing can identify biomarkers which may be targetable. ●Bone biopsy, possibly the bone aspirate liquid biopsy being researched by Peter Kuhn, to be able to analyze bone tumors. What additional treatment options were suggested?

●An Androgen Receptor (AR) degrader (ARV-110 or ARV-766 clinical trial), given the high expression of AR as noted in the Caris report. ●CAR-T, if there are indications that an immunotherapy might work.

●Drug combinations of abiraterone + olaparib + sulindac, carboplatin + degarelix + sulindac, apalutamide + lutetium lu 177 vipivotide tetraxetan + sulindac, abiraterone + olaparib, carboplatin + degarelix, and apalutamide + lutetium lu 177 vipivotide tetraxetan The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.

You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.

“Testing and Treatment Options Review for Robert Ellis” (Robert Ellis) [#39] Meeting Notes The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.

You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.

SUMMARY KEYWORDS psa, treatment, tissue, started, report, liquid biopsy, clinical trial, adt, robert, chemo, biopsy, test, cancer, respond, little bit, therapy, psm, scan, chemotherapy, metastases SPEAKERS Robert Ellis (62%), Brian McCloskey (10%), Rick Stanton (9%), Amit Gattani (6%), Brad Power (6%), Ally Perlina (4%), Mike Yancey (3%) Brad Power Today is the type of Prostate Cancer Lab meeting where we have one of the patients in our community review his case.

Today we are going to hear from Robert Ellis. Please note that the Information and opinions shared on this website or platform or during discussions and presentations are not intended as medical advice. It is important to consult with a healthcare professional about your specific situation before making any decisions related to your health.

Also, everything that you say can and will be made public. Anyone who speaks, I always send out the transcript for an opportunity to review and revise.

apy. ●Whole genome and RNA sequencing can identify biomarkers which may be targetable. ●Bone biopsy, possibly the bone aspirate liquid biopsy being researched by Peter Kuhn, to be able to analyze bone tumors. What additional treatment options were suggested? ●An Androgen Receptor (AR) degrader (ARV-110 or ARV-766 clinical trial), given the high expression of AR as noted in the Caris report.

●CAR-T, if there are indications that an immunotherapy might work.

●Drug combinations of abiraterone + olaparib + sulindac, carboplatin + degarelix + sulindac, apalutamide + lutetium lu 177 vipivotide tetraxetan + sulindac, abiraterone + olaparib, carboplatin + degarelix, and apalutamide + lutetium lu 177 vipivotide tetraxetan The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.

You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.

“Testing and Treatment Options Review for Robert Ellis” (Robert Ellis) [#39] Meeting Notes The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.

You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.

SUMMARY KEYWORDS psa, treatment, tissue, started, report, liquid biopsy, clinical trial, adt, robert, chemo, biopsy, test, cancer, respond, little bit, therapy, psm, scan, chemotherapy, metastases SPEAKERS Robert Ellis (62%), Brian McCloskey (10%), Rick Stanton (9%), Amit Gattani (6%), Brad Power (6%), Ally Perlina (4%), Mike Yancey (3%) Brad Power Today is the type of Prostate Cancer Lab meeting where we have one of the patients in our community review his case.

Today we are going to hear from Robert Ellis. Please note that the Information and opinions shared on this website or platform or during discussions and presentations are not intended as medical advice. It is important to consult with a healthcare professional about your specific situation before making any decisions related to your health.

Also, everything that you say can and will be made public. Anyone who speaks, I always send out the transcript for an opportunity to review and revise. We will not publish anything unless anyone who says something approves it. Those are our standards.

ny decisions related to your health. Also, everything that you say can and will be made public. Anyone who speaks, I always send out the transcript for an opportunity to review and revise. We will not publish anything unless anyone who says something approves it. Those are our standards. We have to make sure that everyone is protected from anything that they might say.

Robert is going to review his case and look for some feedback on ideas to help him with his testing and treatment decisions. Robert Ellis (1:27) I want to thank everybody for this opportunity to get your input and review my case. I apologize in advance that I don't have as much information as I'd hoped to have.

I was scheduled to have a PSMA scan, and I had a biopsy in October that did not reveal any usable tissue. My primary aims for this call are: I would love some guidance on specifically what kind of testing options I should talk to my doctor about to be able to identify some markers that might be targetable for treatment.

And the second thing is: right now in my conversations with my oncologist, I really have two treatment options in the wings.

“Testing and Treatment Options Review for Robert Ellis” (Robert Ellis) [#39] aligned with my sort of treatment principles which I'll share. And possibly combination treatments and things like that. In other words, what other things should I be talking to my doctor about or see if I can get lined up for after the current treatment that I'm on, after I stop responding to my current treatment.

A little bit of a disclaimer: last night I saw Rick's email and looked at his depiction of his cancer history and was a little intimidated. And then I thought, I better go through all my notes on the Google Drive. And I found Brian's files, and that was pretty intimidating too. I'm going to show you an unfinished symphony.

I'm inspired by the work that Rick and Brian have done, and I'm going to be more diligent about maintaining my records going forward. Rick Stanton (3:40) Don't forget Eric. He did a really cool depiction as well. Robert Ellis (4:09) Here is my spreadsheet with a complete record of my PSA. I have not added a legend like in Rick's beautiful charts.

“Testing and Treatment Options Review for Robert Ellis” (Robert Ellis) [#39] This chart here was provided by xCures. It's a little out of date. They put this together for me back in 2021. The reason I haven't had an updated one is I keep waiting to get new test results, but then I haven't gotten any. I was diagnosed on October 23, 2017. When I had my first PSA, it was 22.3.

The initial spike is because it took me a while before I began treatment. Shortly after that I went on a clinical trial. I started on ADT, which on the xCures chart was casodex followed by Lupron. Then abiraterone was added.

is because it took me a while before I began treatment. Shortly after that I went on a clinical trial. I started on ADT, which on the xCures chart was casodex followed by Lupron. Then abiraterone was added. I was on a clinical trial at UCSF, which was a combination of five treatments of focal radiation to the prostate, and 13 rounds of pembrolizumab every three weeks. I responded well.

It was difficult to say whether that was the ADT or the clinical trial, but I responded pretty well. By May of 2019, my PSA was fractional at 0.384. When I was at the end of this clinical trial, they stopped everything. I had no treatment at all. I felt really good for about three or four months, but at around five months I started to have pain again.

I have metastases to my tissue of tuberosities (a large prominence on a bone usually serving for the attachment of muscles or ligaments). When I had the next PSA, I was at 28.73. So they started me on ADT again, Lupron and abiraterone, and then responded to that. At the beginning of 2021 I started to become castrate resistant. I was on the same treatment but my PSA was rising.

The next drop is where I started dutasteride, which is known to give a false PSA drop. It showed my PSA dropped when I began dutasteride, but it was not. It wasn't really treating the cancer. It was a false reading, and it spiked again after that.

“Testing and Treatment Options Review for Robert Ellis” (Robert Ellis) [#39] I began chemotherapy in October of 2021. The chemotherapy was a combination of carboplatin, because I have BRCA2, and docetaxel, initially, at a total of 16 rounds. Three of those were carboplatin and cabazitaxel. I asked to try cabazitaxel to see if the side effects were any less onerous than the docetaxel.

They were worse: more neuropathy in my feet, which I still have. But I responded pretty well to chemotherapy for some time. When my PSA started to go up again, we stopped the chemotherapy, and I began Rubraca (rucaparib, a PARP inhibitor). That was partly because earlier xCures had recommended a clinical trial that was a combination of olaparib and radium 233.

Olaparib had always been in the wings, but I was advised not to do a PARP inhibitor earlier because there was a new generation in the works, and Rubraca was one of those. By the time the chemotherapy began to fail, I started the Rubraca. Just after I started the Rubraca I managed to get my oncologist Dr. Koontz to speak with Dr. McKay about bipolar androgen therapy.

It took a while for them to connect. In that interim, we started the Rubraca so that I would be on some treatment. I'm responding to it. So we'll continue until I stop responding. Dr. Koontz was open to considering bipolar androgen therapy. After that, though, I learned that there are some risks involved and the responses are mixed. I have had CT scans during 2018 and 2019 Those were all stable.