Pembrolizumab for high TMB castration-resistant prostate cancer: A precision medicine case report.

IF 0.5 Q4 ONCOLOGY

International Cancer Conference Journal Pub Date : 2026-01-12 eCollection Date: 2026-04-01 DOI:10.1007/s13691-025-00833-3

Vincenzo Terrano, Erica Perri, Chiara Cioffo, Giusi Mastroianni, Maria Antonina Palumbo, Fortunato Ciardiello, Teresa Troiani, Stefania Napolitano

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引用次数: 0

Abstract

This case report describes the clinical management of a 68-year-old man with concurrent invasive melanoma and metastatic castration-resistant prostate cancer (mCRPC). Initially diagnosed with BRAF V600E-mutated melanoma, he received Dabrafenib and Trametinib. Later, prostate cancer was diagnosed with bilateral pulmonary metastases. Despite initial treatment with Triptorelin, Docetaxel, and Abiraterone, disease progression occurred. A liquid biopsy revealed an extremely high Tumor Mutational Burden (TMB) and mutations including POLE, BRCA2, ATM, and TP53. Due to the high TMB, off-label Pembrolizumab was initiated. Radiological evaluations at 3 and 6 months showed a marked response, with disappearance of target lung metastases and durable remission maintained through February 2025. Only grade 1 asthenia was reported, without significant treatment interruptions. This case illustrates the value of precision medicine and the role of liquid biopsy in guiding immunotherapy decisions for complex oncological cases. It supports the relevance of molecular profiling in selecting effective treatments beyond standard indications.

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派姆单抗治疗高TMB去势抵抗性前列腺癌：一个精准医学病例报告。

本病例报告描述了一名68岁男性并发侵袭性黑色素瘤和转移性去势抵抗性前列腺癌（mCRPC）的临床处理。最初诊断为BRAF v600e突变黑色素瘤，他接受了达拉法尼和曲美替尼治疗。后来，前列腺癌被诊断为双侧肺转移。尽管最初使用雷普妥林、多西他赛和阿比特龙治疗，疾病仍发生进展。液体活检显示极高的肿瘤突变负担（TMB）和突变，包括POLE， BRCA2， ATM和TP53。由于高TMB，启动了Pembrolizumab的标签外治疗。3个月和6个月的放射学评估显示有明显的反应，靶肺转移灶消失，持续缓解持续到2025年2月。只有1级虚弱被报道，没有明显的治疗中断。这个病例说明了精确医学的价值和液体活检在指导复杂肿瘤病例免疫治疗决策中的作用。它支持分子谱在选择标准适应症之外的有效治疗方面的相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Cancer Conference Journal ONCOLOGY-

自引率

14.30%

发文量

期刊介绍： This online-only journal publishes original case reports on all types of cancer. In particular, we welcome not only case reports of educational value in the diagnosis and treatment of cancers, but also reports on molecularly analyzed cancer cases, including gene mutations, gene fusions, gene expression, and changes in copy number, regardless of their known clinical significance. Assessing the molecular analysis of a tumor usually requires a “cancer conference” in which experts from various fields discuss it. Even if the authors and their respective “cancer conference” were unable to determine the clinical significance of molecular changes at the time of submission and publication, their data may provide evidence that will help the scientific community develop precision medicine solutions in the future. We welcome case reports with reviews of the literature on similar cases, as they are more useful and valuable to readers than are reports of rare cases. International Cancer Conference Journal is the official publication of the Japan Society of Clinical Oncology (JSCO). - Presents an online-only collection of original case reports on all types of cancer - In particular, welcomes molecularly analyzed cancer cases - The Official Publication of the Japan Society of Clinical Oncology (JSCO)