Pembrolizumab for treatment-related neuroendocrine prostate carcinoma with a high tumor mutational burden: a case report
Pembrolizumab has emerged as a significant therapeutic option for the treatment of solid tumors with a high tumor mutational burden (TMB-high). However, there have been no reports of its use in treatment-related neuroendocrine prostate carcinoma (t-NEPC) with TMB-high. We present the case of a 66-ye...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1642412/full |
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| author | Keiji Shiba Motohiro Fujiwara Ayaka Onuki Daisuke Kato Takeshi Shirakawa Yohei Shimizu Takumasa Amemiya Tsunehiro Nenohi Yuki Matsumoto Masayasu Urushibara Hideto Kano Kazuhiro Ishizaka Mikiko Takahashi Minato Yokoyama |
| author_facet | Keiji Shiba Motohiro Fujiwara Ayaka Onuki Daisuke Kato Takeshi Shirakawa Yohei Shimizu Takumasa Amemiya Tsunehiro Nenohi Yuki Matsumoto Masayasu Urushibara Hideto Kano Kazuhiro Ishizaka Mikiko Takahashi Minato Yokoyama |
| author_sort | Keiji Shiba |
| collection | DOAJ |
| description | Pembrolizumab has emerged as a significant therapeutic option for the treatment of solid tumors with a high tumor mutational burden (TMB-high). However, there have been no reports of its use in treatment-related neuroendocrine prostate carcinoma (t-NEPC) with TMB-high. We present the case of a 66-year-old man with metastatic prostate cancer (adenocarcinoma with a Gleason score of 4 + 5, initial prostate-specific antigen [PSA] level of 267 ng/mL, clinical stage T3bN0M1b) who was initially treated with doublet therapy, including apalutamide and leuprorelin, leading to a reduction in circulating levels of PSA < 0.001 ng/mL. However, 35 months after diagnosis, a retroperitoneal mass developed and neuron-specific enolase (NSE) levels were elevated 62.6 ng/mL. Computed tomography-guided biopsy of the tumor confirmed metastasis of t-NEPC, while genetic profiling revealed a TMB-high status. Pembrolizumab treatment was initiated at the 39-month after diagnosis. At the 41-month after diagnosis, a 75% reduction in the retroperitoneal mass and a decrease in NSE levels to 31 ng/mL were observed. This case suggests that pembrolizumab is a potential treatment option for t-NEPCs with TMB-high. |
| format | Article |
| id | doaj-art-d3bf28d9478345aa8ddf1b13c823d092 |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-d3bf28d9478345aa8ddf1b13c823d0922025-08-20T03:58:11ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-08-011510.3389/fonc.2025.16424121642412Pembrolizumab for treatment-related neuroendocrine prostate carcinoma with a high tumor mutational burden: a case reportKeiji Shiba0Motohiro Fujiwara1Ayaka Onuki2Daisuke Kato3Takeshi Shirakawa4Yohei Shimizu5Takumasa Amemiya6Tsunehiro Nenohi7Yuki Matsumoto8Masayasu Urushibara9Hideto Kano10Kazuhiro Ishizaka11Mikiko Takahashi12Minato Yokoyama13Department of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Pathology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanDepartment of Urology, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, JapanPembrolizumab has emerged as a significant therapeutic option for the treatment of solid tumors with a high tumor mutational burden (TMB-high). However, there have been no reports of its use in treatment-related neuroendocrine prostate carcinoma (t-NEPC) with TMB-high. We present the case of a 66-year-old man with metastatic prostate cancer (adenocarcinoma with a Gleason score of 4 + 5, initial prostate-specific antigen [PSA] level of 267 ng/mL, clinical stage T3bN0M1b) who was initially treated with doublet therapy, including apalutamide and leuprorelin, leading to a reduction in circulating levels of PSA < 0.001 ng/mL. However, 35 months after diagnosis, a retroperitoneal mass developed and neuron-specific enolase (NSE) levels were elevated 62.6 ng/mL. Computed tomography-guided biopsy of the tumor confirmed metastasis of t-NEPC, while genetic profiling revealed a TMB-high status. Pembrolizumab treatment was initiated at the 39-month after diagnosis. At the 41-month after diagnosis, a 75% reduction in the retroperitoneal mass and a decrease in NSE levels to 31 ng/mL were observed. This case suggests that pembrolizumab is a potential treatment option for t-NEPCs with TMB-high.https://www.frontiersin.org/articles/10.3389/fonc.2025.1642412/fullpembrolizumabprostate cancertumor mutational burdentreatment-related neuroendocrine prostate carcinomaimmune checkpoint inhibitors |
| spellingShingle | Keiji Shiba Motohiro Fujiwara Ayaka Onuki Daisuke Kato Takeshi Shirakawa Yohei Shimizu Takumasa Amemiya Tsunehiro Nenohi Yuki Matsumoto Masayasu Urushibara Hideto Kano Kazuhiro Ishizaka Mikiko Takahashi Minato Yokoyama Pembrolizumab for treatment-related neuroendocrine prostate carcinoma with a high tumor mutational burden: a case report Frontiers in Oncology pembrolizumab prostate cancer tumor mutational burden treatment-related neuroendocrine prostate carcinoma immune checkpoint inhibitors |
| title | Pembrolizumab for treatment-related neuroendocrine prostate carcinoma with a high tumor mutational burden: a case report |
| title_full | Pembrolizumab for treatment-related neuroendocrine prostate carcinoma with a high tumor mutational burden: a case report |
| title_fullStr | Pembrolizumab for treatment-related neuroendocrine prostate carcinoma with a high tumor mutational burden: a case report |
| title_full_unstemmed | Pembrolizumab for treatment-related neuroendocrine prostate carcinoma with a high tumor mutational burden: a case report |
| title_short | Pembrolizumab for treatment-related neuroendocrine prostate carcinoma with a high tumor mutational burden: a case report |
| title_sort | pembrolizumab for treatment related neuroendocrine prostate carcinoma with a high tumor mutational burden a case report |
| topic | pembrolizumab prostate cancer tumor mutational burden treatment-related neuroendocrine prostate carcinoma immune checkpoint inhibitors |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1642412/full |
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