Assessment of the Safety of Glucocorticoid Regimens in Combination With Abiraterone Acetate for Metastatic Castration-Resistant Prostate Cancer

Attard, Gerhardt; Merseburger, Axel S.; Arlt, Wiebke; Sternberg, Cora N.; Feyerabend, Susan; Berruti, Alfredo; Joniau, Steven; Gergely, Lajos; Lefresne, Florence; Lahaye, Marjolein; Shelby, Florence Nave; Pissart, Geneviève; Chua, Sue; Jones, Robert J.; Tombal, Bertrand

doi:10.1001/jamaoncol.2019.1011

Cited by 49 publications

(39 citation statements)

References 13 publications

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“…Previous studies demonstrate relationships between ARSi therapy and lipid metabolism and statin use (23)(24)(25). Both abiraterone and enzalutamide can induce increases in body fat mass and decreases in lean body mass (26,27). However, the relationship between body composition and the response to ARSi in CRPC patients is largely unknown.…”

Section: Discussionmentioning

confidence: 99%

Association of Body Composition With Survival and Treatment Efficacy in Castration-Resistant Prostate Cancer

et al. 2020

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Objectives: The association of body composition with survival and the efficacy of first-line treatment was investigated in patients with castration-resistant prostate cancer (CRPC). Methods: The records of CRPC patients treated with docetaxel or androgen receptor signaling inhibitors (ARSi) between 2005 and 2018 were reviewed. Skeletal muscle index (SMI), visceral fat index, and subcutaneous fat index were evaluated using pretreatment computed tomography images. Results: Of 230 eligible patients, 144 received docetaxel, and 86 received ARSi as the first-line treatment for CRPC. The SMI hi (based on median values) group had higher prostate-specific antigen (PSA) progression-free survival (median 13.5 vs. 8.3 months, p = 0.030), radiologic progression-free survival (14.9 vs. 9.1 months, p < 0.001), and overall survival (24.1 vs. 16.9 months, p = 0.015) than the SMI lo group. In docetaxel-treated patients, the SMI hi group had higher PSA progression-free survival (13.5 vs. 5.9 months, p = 0.016) and radiologic progression-free survival (14.6 vs. 6.7 months, p < 0.001) than the SMI lo group. However, PSA progression-free survival and radiologic progression-free survival were comparable between the two groups in ARSi-treated patients. SMI was independently associated with the risk of radiologic progression in patients treated with docetaxel but not in those treated with ARSi. Conclusions: High skeletal muscle mass may be associated with reduced risk of disease progression and mortality in patients with CRPC. However, the significance of these relationships is limited in patients treated with docetaxel. These results suggest that assessing skeletal muscle mass may be worthwhile when selecting treatments for CRPC; however, further prospective validation and large-scale studies are needed.

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Section: Discussionmentioning

confidence: 99%

Association of Body Composition With Survival and Treatment Efficacy in Castration-Resistant Prostate Cancer

et al. 2020

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“…In our study, no glucocorticoid-related side effects were reported in postdocetaxel patients with mCRPC. However, limited patients were included in Atarrd et al [19] and our studies. Therefore, further studies are required to evaluate the possible side effects induced by oral glucocorticoids.…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience of Steroid Switch from Prednisone to Dexamethasone in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Abiraterone Acetate

et al. 2020

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Objective: To evaluate the therapeutic efficacy of a steroid switch from prednisone to dexamethasone in Asians with metastatic castration-resistant prostate cancer (mCRPC) that progressed after docetaxel chemotherapy. Methods: This study included postdocetaxel patients with mCRPC treated with abiraterone acetate combined with prednisone (AA + P) who had experienced prostate-specific antigen (PSA) progression. All patients underwent a steroid switch from prednisone (10 mg/day) to dexamethasone (1 mg/day). The PSA level and clinical symptoms were recorded. Moreover, follow-up was conducted until patients were either lost to follow-up or death. Results: This study included 11 patients from a single center in Taiwan. The median follow-up time starting from AA + P treatment was 19.47 months. Seven patients (63.64%) had >30% PSA decline, and 6 patients (54.55%) had >50% PSA decline. The median percentage of PSA decline was 83.6%. The median time until PSA progression after the steroid switch was 11.38 months. No adverse events greater than grade 3 were noted. Conclusions: Steroid switching is a feasible and effective therapy in docetaxel-treated Asian patients with mCRPC.

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“…This lower dosage of prednisolone has been cited as a reason for the relatively high proportion of mineralcorticoid-related adverse events, including fluid retention, hypertension and hypokalaemia, among participants in the LATITUDE trial. The co-administration of different glucorticoid regimens with abiraterone acetate in patients with mCRPC has been explored in a prospective clinical trial, with the results suggesting there is little scope for reducing prednisolone doses while still preventing mineralcorticoid excess [48].…”

Section: Concomitant Steroid Administrationmentioning

confidence: 99%

Metastatic Hormone-Sensitive Prostate Cancer (mHSPC): Advances and Treatment Strategies in the First-Line Setting

Smith

Shamash

2020

Oncol Ther

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The treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC) has changed radically in recent years. Androgen deprivation therapy (ADT) alone was for decades the standard of care for treating mHSPC. This changed when studies showed that the addition of docetaxel chemotherapy or abiraterone acetate to ADT significantly increases overall survival of patients with mHSPC, followed by more recent evidence showing the efficacy of androgen receptor antagonists, such as enzalutamide and apalutamide, in this setting. While this rapid therapeutic evolution is welcome, it presents clinicians with a crucial challenge: the choice of treatment selection and sequencing. In the first-line setting there are no comparative data currently available to guide treatment choice between the different available regimens, and no prospective data to guide clinical decision after progression. Decisions on treatment will now need to be personalised based on indirect comparison of the available efficacy data from multiple phase 3 studies, together with considerations of disease volume, comorbidities, treatment aims, toxicity profile and cost reimbursement within the healthcare setting. Here, we provide an overview of the clinical trial data to date and propose some biological and clinical insights which may be helpful in making decisions on treatment selection and sequencing.

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Assessment of the Safety of Glucocorticoid Regimens in Combination With Abiraterone Acetate for Metastatic Castration-Resistant Prostate Cancer

Cited by 49 publications

References 13 publications

Association of Body Composition With Survival and Treatment Efficacy in Castration-Resistant Prostate Cancer

Association of Body Composition With Survival and Treatment Efficacy in Castration-Resistant Prostate Cancer

Clinical Experience of Steroid Switch from Prednisone to Dexamethasone in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Abiraterone Acetate

Metastatic Hormone-Sensitive Prostate Cancer (mHSPC): Advances and Treatment Strategies in the First-Line Setting

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