Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Feb 10;102(6):e32870.
doi: 10.1097/MD.0000000000032870.

Personalized downstaging treatment with ADT, chemotherapy and add-on zimberelimab for very-high-risk clinically localized prostate cancer: A case report

Jie Li  1 , Tengfei Gu  1 , Shengping Hu  1 , Liang Wang  2 , Ting Chen  1
Affiliations
Case Reports

Personalized downstaging treatment with ADT, chemotherapy and add-on zimberelimab for very-high-risk clinically localized prostate cancer: A case report

Jie Li et al. Medicine (Baltimore). .

Abstract

Rationale: Very-high-risk prostate cancer (PCa) is associated with poor prognosis. Radical prostatectomy (RP) is an option for selected high-risk PCa cases, especially in younger, healthier patients. However, a high Gleason score and high T stage can increase the risk of RP. Neoadjuvant therapy has been reported in high- or very-high-risk PCa, but its clinical use remains controversial.

Diagnoses and patient concerns: A 53-year-old male patient diagnosed with PCa was referred to our hospital. The patient's Gleason score was 4 + 5, and the clinical stage was T4N0M0, with an abnormally enlarged prostate adhering to the rectum and leading to decreased mobility of the rectum, suggesting a very-high-risk PCa inappropriate for RP. However, instead of external beam radiation therapy, which is the standard treatment for inoperable PCa, the patient insisted on RP.

Interventions: Androgen deprivation therapy plus docetaxel was chosen as the first downstaging treatment; however, the tumor was too slightly downsized to undergo RP. Therefore, zimberelimab was added after confirmation of a genomic feature of high microsatellite instability and high tumor mutational burden status.

Outcomes: After 4 doses of zimberelimab, the prostate shrank significantly. The patient successfully completed RP after another dose of zimberelimab, and achieved a pathological complete response (pCR).

Lessons: Our case represents a successful attempt at personalized treatment and provides preliminary evidence for the clinical use of downstaging therapy of androgen deprivation therapy, chemotherapy, and add-on zimberelimab for very-high-risk clinically localized PCa.

PubMed Disclaimer

Conflict of interest statement

LW is employee of Guangzhou Gloria Biosciences. The other authors declare that this report was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1.
Figure 1.
MRI of prostate disease at baseline and course of treatment. A)MRI results of baseline on 2022-03-20. Size of prostate: 5.3*6.0*5.7cm B) MRI results after 2 courses of bicalutamide and 3 courses of docetaxel on 2022-05-20. Size of prostate: 4.7*4.5*5.2cm. C) MRI results after 4 courses of zimberelimab on 2022-08-15. Size of prostate: 2.8*3.0*3.6cm. MRI = magnetic resonance imaging.
Figure 2.
Figure 2.
PET-CT of prostate disease at baseline on 2022-03-28. PET-CT = positron emission tomography-computed tomography.
Figure 3.
Figure 3.
Pathological complete response of RP tissue. RP = radical prostatectomy.
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, et al. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. - PubMed
    1. Schaeffer EM, Srinivas S, et al. . NCCN Clinical Practice Guidelines in Oncology-Prostate Cancer (Version 1.2023 – September 16, 2022). http://www.nccn.org/.
    1. Akre O, Garmo H, Adolfsson J, et al. . Mortality among men with locally advanced prostate cancer managed with noncurative intent: a nationwide study in PCBaSe Sweden. Eur Urol. 2011;60:554–63. - PubMed
    1. Rider JR, Sandin F, Andrén O, et al. . Long-term outcomes among noncuratively treated men according to prostate cancer risk category in a nationwide, population-based study. Eur Urol. 2013;63:88–96. - PubMed
    1. Tafuri A, Cerruto MA, Antonelli A. Neoadjuvant strategies before radical prostatectomy for high risk prostate cancer in the era of new hormonal agents. Curr Drug Targets. 2021;22:68–76. - PubMed

Publication types