The American Oncology Institute (AOI) at Citizens Specialty Hospital in Hyderabad is pleased to announce the successful treatment of a 72-year-old male patient with advanced prostate cancer. The patient, who initially experienced acute urinary retention in 2014, consulted a urologist and was diagnosed with prostate carcinoma after a biopsy. He underwent bilateral orchidectomy and received multiple lines of chemotherapy at different hospitals, experiencing several relapses. In 2022, the patient returned to AOI with a recurrence of the disease but surprisingly low PSA levels. The doctors at AOI decided to perform a repeat biopsy, which revealed a transitional cell variant of prostate carcinoma. Considering the patient’s age, frailty, and extensive prior treatments, the medical team conducted next-generation sequencing on the tumor tissue, which showed MSI high and TMB high status, warranting immunotherapy. Dr. K.V. Krishnamani, Medical Oncologist at AOI, explained the multidisciplinary approach: "The advanced nature of the patient's cancer required a combination of molecular testing and immunotherapy. This comprehensive strategy not only addressed the cancer but also significantly improved the patient's quality of life. His response to the treatment has been very encouraging, showcasing AOI's advanced care capabilities." The patient received immunotherapy every three weeks, and now, two years from the start of this treatment, his disease is in complete remission. He is clinically well, ambulatory, and in much better health than he was in 2022. This case highlights the necessity of specialized molecular testing, the importance of repeat biopsies in recurrence cases, and the excellent results achievable with immunotherapy in such patients. Harish Trivedi, CEO of CTSI-South Asia, emphasized the importance of leveraging cutting-edge diagnostics and personalized medicine in cancer treatment. Dr. Prabhakar P, Regional COO of AOI, highlighted AOI's commitment to integrating advanced technology with expert clinical knowledge to provide personalized treatment plans. Dr. Krishnamani also stressed the importance of regular screenings for early detection of prostate cancer, which significantly improves treatment outcomes. He encourages all men over 50 and those with a family history of the disease to undergo routine check-ups and screenings.
Read morePatient Profile:
- Age/Gender: 48-year-old male
- Diagnosis:Diffuse Large B-Cell Lymphoma (DLBCL)
- History: Multiple lines of treatment, post-autotransplant, and post-CAR-T therapy
- Current Status: Development of new liver lesions
Challenge:
A traditional biopsy for Next-Generation Sequencing (NGS) based molecular testing was not feasible due to the unavailability of a suitable biopsy sample.
Innovative Approach:
For the first time in the country, a liquid biopsy based NGS was performed using circulating tumor DNA (ctDNA) isolated from peripheral blood. This approach is particularly beneficial in cases where a traditional biopsy is not possible.
Methodology:
- Technique: Liquid biopsy based NGS
- Sample: ctDNA from peripheral blood
- Panel: 95-gene panel designed and validated in-house
- Special Features: The panel categorizes based on new methylation classes and identifies rare poor-risk GCB subtypes by detecting enrichment of specific mutations within these classes.
Findings:
The ctDNA analysis conformed to the disease burden and revealed significant mutations in the following genes:
- TP53
- RNF213
- TNFAIP3
These mutations are associated with relapse/refractory conditions and contribute to an aggressive disease biology.
Conclusion:
This case represents a landmark achievement in India for using ctDNA in a clinical setting for DLBCL. The findings provided crucial insights into why the patient did not respond to previous treatments. This innovative molecular approach demonstrates the potential for improved diagnostic and therapeutic strategies in managing complex cases of DLBCL.
Call to Action:
It is time to embrace and integrate advanced molecular testing technologies. India is poised to lead in this field, ensuring that patients receive the most accurate and effective treatments available.
Acknowledgements
Fortis Health Care
In a groundbreaking medical achievement for Gujarat, the Apollo Cancer Centre (ACC) in Ahmedabad successfully conducted Chimeric Antigen Receptor (CAR) T-cell therapy on a 48-year-old woman with relapsed acute lymphoblastic leukemia, alongside complex co-morbidities.
“Performing CAR T-cell therapy in such a challenging scenario, compounded by the patient’s existing health conditions, required exceptional expertise,” explained Lt Gen Dr Velu Nair, the Head & Chief Consultant of Haemato-Oncology & Bone Marrow Transplant at Apollo Cancer Centre, Ahmedabad.
Having previously undergone an allogenic bone marrow transplant, the patient achieved molecular remission post-immunotherapy, paving the way for CAR T-cell therapy.
“This case represents a significant milestone in Gujarat’s medical landscape and signifies a major leap forward in treating relapsed acute lymphoblastic leukemia,” remarked Dr Nair.
Neeraj Lal, the COO and Unit Head of Apollo Cancer Centre in the Gujarat Region, emphasized, “The success of the CAR T-cell therapy underscores our unwavering dedication to offering state-of-the-art treatments and underscores our capacity to manage intricate medical conditions.”