Metastatic Prostate Cancer Treated with TPGS-Docetaxel-Based Chemotherapy: A Case Profile - Dr Kaushal Patel

Case Overview

A 61-year-old male with ECOG performance status 1 presented with bone pain. He was diagnosed with adenocarcinoma prostate, Gleason Score 9 (4+5), with Stage IV metastatic prostate cancer involving bone metastases. The disease was HRR-positive, indicating a high-risk metastatic profile.

Clinical Impression and Baseline Evaluation

The clinical impression was adenocarcinoma prostate with Stage IV metastatic disease and skeletal involvement. PET-CT showed primary prostate malignancy with multiple skeletal metastases. Biopsy and histopathology confirmed adenocarcinoma prostate, Gleason Score 9 (4+5). Molecular/genetic evaluation showed HRR-positive disease.

Figure 1.  Baseline PET-CT showing multiple skeletal metastases in metastatic prostate cancer.

Diagnosis and Risk Stratification

The final diagnosis was adenocarcinoma prostate, Gleason Score 9 (4+5), Stage IV metastatic prostate cancer with bone metastases. The case was categorized as high-risk metastatic prostate cancer.

Treatment Plan

The treatment goals were to achieve systemic disease control, reduce skeletal metastatic burden, improve bone pain and clinical symptoms, and maintain treatment continuity with good tolerability.

The first-line regimen included TPGS-Docetaxel, given as BSA-based dosing with a calculated administered dose of 100 mg every 21 days, along with Carboplatin and Denosumab. Denosumab was included as supportive therapy.

Formulation Advantage in This Case

TPGS-Docetaxel was considered in this case due to the need for effective systemic therapy in high-risk metastatic prostate cancer with multiple skeletal metastases. The patient had HRR-positive disease, suggesting an aggressive metastatic profile.

In this case, treatment was tolerated without infusion reaction. The formulation was also selected to support tolerability and reduce concerns related to docetaxel polysorbate-80–associated toxicities.

Follow-Up and Response Evaluation

On follow-up, interim PET/CT showed marked clinical and radiological improvement. A PET scan performed after 6 cycles showed radiological response, with approximately 80% tumour and PSA reduction. Treatment was continued.

Figure 2. Follow-up PET-CT showing radiological response after 6 cycles of TPGS-Docetaxel-based chemotherapy.

Patient Outcomes and Tolerability

The patient is alive and under follow-up. Treatment was well tolerated, with no dose interruption or discontinuation. Functional status and quality of life were maintained, with a good treatment response reported.

Peripheral neuropathy was manageable. Adverse events included Grade 1 neuropathy and Grade 2 loose motion. No life-threatening adverse events or infusion-related reactions were reported.

Treatment Experience Insights

This case highlights the role of TPGS-Docetaxel-based chemotherapy in a high-risk metastatic prostate cancer patient with HRR-positive disease. Favorable tolerability may help facilitate treatment completion and improve patient experience in selected patients.

Key Learning Points

• This case demonstrated response with TPGS-Docetaxel-based chemotherapy in high-risk metastatic prostate cancer.
• HRR-positive metastatic disease can achieve deep responses with appropriate systemic therapy.
• Favorable tolerability with Docetaxel TPGS formulation may facilitate better tolerance, treatment completion, and patient experience.

Abbreviations

CA: Carcinoma; TPGS: D-alpha-tocopheryl polyethylene glycol succinate; ECOG: Eastern Cooperative Oncology Group; HRR: Homologous Recombination Repair; PET-CT: Positron Emission Tomography–Computed Tomography; CT: Computed Tomography; PSA: Prostate-Specific Antigen; QoL: Quality of Life; mg: Milligram; Fig.: Figure; BSA: Body Surface Area.

Disclaimer

For the use of a registered medical practitioner, hospital or laboratory only. This case profile is intended for scientific and educational discussion among healthcare professionals. Clinical decisions should be individualized based on patient profile, disease status, treating physician judgement, and applicable prescribing information.