Amrubicin is effective against small cell carcinoma of the prostate as a second‐line chemotherapeutic agent: A case report

Abstract

Abbreviations & Acronyms AC = adenocarcinoma ADT = androgen deprivation therapy ALP = alkaline phosphatase AMR = amrubicin CAB = combined androgen blockade CE = carboplatin and etoposide CI = carboplatin and irinotecan CMR = complete metabolic response CT = computed tomography FDG = fluorodeoxyglucose GS = Gleason score OS = overall survival PE = cisplatin and etoposide PET = positron emission tomography PI = cisplatin and irinotecan ProGRP = pro-gastrinreleasing peptide PSA = prostate-specific antigen RP = radical prostatectomy RT = radiation therapy SCC = small cell carcinoma SCCP = small cell carcinoma of the prostate SCLC = small cell lung cancer Introduction: Small cell carcinoma of the prostate has a poor prognosis. Furthermore, treatments for small cell carcinoma of the prostate have not been established. We report a case where amrubicin was effective for second-line chemotherapy. Case presentation: A 50-year-old man complaining of painful micturition was referred to our hospital. Due to high prostate-specific antigen level (16.57 ng/mL) and abnormal magnetic resonance imaging findings (cT2c), prostate biopsy was performed; mixed adenocarcinoma and small cell carcinoma of the prostate were observed. Radical prostatectomy was performed following a cT2cN0M0 diagnosis. One month after prostatectomy, fluorodeoxyglucose positron emission tomography/computed tomography showed metastatic lesions in the bone; the patient received androgen deprivation therapy and two cycles of cisplatin plus irinotecan. Due to new metastatic lesions and sustained abnormal pro-gastrin-releasing peptide levels, amrubicin was administered for second-line chemotherapy. Pro-gastrin-releasing peptide was normalized and positron emission tomography/computed tomography showed a complete metabolic response after 15 cycles of amrubicin. Conclusion: Amrubicin could serve as a second-line chemotherapeutic agent against small cell carcinoma of the prostate.Key words: small cell carcinoma of the prostate, amrubicin, FDG-PET. Keynote messageSCCP, a tumor seen in 0.5-2% of prostatic primary tumors, is rarely detected and has a poor prognosis. Our findings suggest that AMR, a synthetic anthracycline derivative made in Japan, could serve as a second-line chemotherapeutic agent against SCCP. Moreover, PET/ CT should be considered to estimate the response of chemotherapy against SCCP.

Second-Line Systemic Therapy for Highly Aggressive Neuroendocrine Prostate Cancer

“…AMR is an inhibitor of DNA topoisomerase II. A phase II trial demonstrated that AMR exerted significant activity against refractory or relapsed SCLC after platinumbased chemotherapy (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34).…”

“…In a total of 12 NEPC patients, including 2 cases reported by our group, who had been treated with AMR were identified in the literature (23)(24)(25)(26)(27)(28). First-line therapies for these patients were etoposide plus platinum (N=10) and cisplatin plus irinotecan (N=2).…”

Undesirable Status of Prostate Cancer Cells after Intensive Inhibition of AR Signaling: Post-AR Era of CRPC Treatment

“…Furthermore, in a phase-II GETUG P01 for 60 mCRPC patients with visceral metastases or elevated NE markers, carboplatin/etoposide revealed 8% PSA response, 9% OR of measurable disease, 2.9 months median PFS, and 9.6 months median OS [ 119 ]. Other regimens include cisplatin/irinotecan, carboplatin//irinotecan, gemcitabine/docetaxel/carboplatin, doxorubicin/cisplatin/etoposide, amrubicin, and everolimus [ 120 , 121 , 122 , 123 , 124 ]. Summarizing the data, the survival time is generally reported to be 7–16 months, indicating that the NEPC prognosis and aggressive/anaplastic mCRPC are very poor [ 11 , 125 , 126 ].…”