Substantial tumor regression in prostate cancer patient with extensive skeletal metastases upon Immunotherapy (APCEDEN)

Abstract

Rationale: Prostate cancer along with colorectal and lung cancers accounts for 42% of cancer cases in men globally. It is the first cancer indication for which the use of active immunotherapy, Sipuleucel-T (Provenge) was granted by the FDA in 2010. This study presents a case of prostate carcinoma and the tumour remission observed after administration of a personalised Dendritic cell vaccine (APCEDEN). Patient concerns: A 58 years old Caucasian male diagnosed with prostate carcinoma with GLEASON score 8. The patient had previously been diagnosed with Renal Cell Carcinoma (RCC) in 1996 and had undergone nephrectomy of the right kidney. PET CT scan revealed multiple intensely PSMA avid lesions noted in both lobes of the prostate gland with SUVmax −28.3 and the prostate gland measuring 3.2 × 3.2 cm displaying maximum dimensions. Diagnosis: FNAC followed by PETCT confirmed CA Prostate and further supported by increased serum PSA level. Interventions: The patient underwent personalised Dendritic Cell Immunotherapy APCEDEN regimen of six doses biweekly, in a time frame of 3 months were given both via intravenous and intradermal route. Six months post completion of APCEDEN, the patient was administered 6 booster shots for 6 months. Outcomes: Progressive remission of carcinoma was observed along with reduction in PSA and Testosterone levels. PET CT showed decline in PSMA avidity by 50% with SUVmax −14.0 and normal size and shape of prostate gland. Lessons: Prostate carcinoma is the second most common cancer in men with majority of them exhibiting locally advanced disease. Apparently 20% to 30% of them are categorized as relapsed cases after various therapeutic interventions. Modulating immune system is an emerging therapy termed as Immunotherapy and potentiates the killing cancer cells via immune activation. Interestingly, prostate cancer is slow growing and it provides the scope and time to mount an anti-tumor response which makes it an attractive target for immunotherapy. This case study demonstrates the efficacy of APCEDEN Immunotherapy regimen resulting in a significant disease remission benefiting the patient.

Has the Landscape of Immunotherapy for Prostate Cancer Changed? A Systematic Review and Post Hoc Analysis

“… Sharan et al’s (2020) report comprised a 58-year-old male diagnosed with advanced PCa. The patient had been priorly diagnosed with renal cell carcinoma in 1996 ( Sharan et al, 2020 ). Kumar et al.…”

“… Sharan et al (2020) administered a personalized dendritic cell vaccine (APCEDEN) to one patient with six doses biweekly over 3 months. The intervention was given both intradermally and intravenously ( Sharan et al, 2020 ). Post 6 months, the patient was additionally administered six booster shots over 6 months.…”

“…Sharan et al’s (2020) report comprised a 58-year-old male diagnosed with advanced PCa. The patient had been priorly diagnosed with renal cell carcinoma in 1996 (Sharan et al, 2020). Kumar et al (2019) report a 63-year-old male who was diagnosed with prostate adenocarcinoma, which was at first organ confined and shifted to hormone-refractory metastatic disease 4 years post-initial diagnosis.…”

“…Monge et al (2018) report a case of a 79-year-old male patient with mCRPC with metastasis to the lymph nodes and bone and a history of atrial fibrillation enrolled in a clinical trial for 8 weeks. Sharan et al's (2020) report comprised a 58-yearold male diagnosed with advanced PCa. The patient had been priorly diagnosed with renal cell carcinoma in 1996 (Sharan et al, 2020).…”

“…The therapeutic cancer vaccine and immune checkpoint inhibitor (ICI) together were utilized to induce anti-tumor activities through immunogenic intensification (Monge et al, 2018). Sharan et al (2020) administered a personalized dendritic cell vaccine (APCEDEN) to one patient with six doses biweekly over 3 months. The intervention was given both intradermally and intravenously (Sharan et al, 2020).…”