19 Feb Patient overcomes metastatic prostate cancer thanks to clinical trial

By Sara Benzel, UW Health

In February 2010, Gary Davey did not think he had any reason to worry about a routine physical exam and blood test to qualify for health insurance through his wife’s new job.

However, the blood test yielded a worrisome result. Davey’s prostate-specific antigen, or PSA, levels were quite high, a sign of prostate cancer. Experts consider a PSA greater than four abnormal and Davey’s PSA results came back at 28.

“I called my doctor and told him the results, and he didn’t believe me,” Davey said. “He said, ‘I bet it was 2.8, we’ll do the test again.’ “

The second test showed even higher PSA levels.

“My doctor said, ‘If you don’t find the best surgeon, you won’t make it to Christmas, Gary,’ ” Davey said. “I said, ‘Well, we’ll see about that.’ ”

Davey, who lives in Dixon, Ill., began coming to UW Health | Carbone Cancer Center in Madison for treatment immediately, which included receiving a radical prostatectomy, a procedure that removes the prostate gland and surrounding lymph nodes, then daily radiation treatment for seven weeks several months later.

However, while treatments and clinical trials, including immunotherapy and hormone therapies, would work for a year or two, the cancer would always develop resistance.

“We’d try a new treatment, and it would work for a little while, but it would stop working sooner than the doctors thought it would,” Davey said.

At one point, the cancer had not only progressed but spread to Davey’s bones, including his ribs, pelvis and spine.

“My ribs looked like Swiss cheese on the X-ray images, with all the lesions visible,” Davey said.

This is common for patients who have the BRCA2 genetic mutation, according to Dr. Josh Lang, professor of medicine, medical oncologist and associate director of translational research at the Carbone Cancer Center, and Davey’s physician since 2015. This genetic mutation, which is most known for raising the risk of breast cancer, is almost as likely to cause prostate cancer in men, according to Lang.

“The BRCA2 mutation can not only increase the risk of cancer but also make the cancer more aggressive and therapy-resistant,” he said.

This is why genetic testing for patients with cancer is so important, according to Lang.

“Genetic testing shows us what we’re up against and can even identify new ways we can treat the cancer,” he said.

That turned out to be the case for Davey. In December 2019, Davey’s PSA was up to 1,280. Fortunately, Lang was able to enroll him in a new phase 1 clinical trial in January 2020 for patients with prostate cancer who have the BRCA2 gene mutation. The trial tested a precision therapy that combined niraparib, a cancer drug that inhibits cancer cells from repairing damaged DNA, and abiraterone, a hormone therapy.

“Two months after he started the trial, his PSA dropped by 90%,” Lang said. “Now, four years later, his PSA is undetectable and his lesions have disappeared.”

This drug combination has recently been approved by the U.S. Food and Drug Administration, he said. Read more …